Provider Demographics
NPI:1962464503
Name:EAPEN, SANTHOSH (MD)
Entity Type:Individual
Prefix:
First Name:SANTHOSH
Middle Name:
Last Name:EAPEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 DAVIS AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-4401
Mailing Address - Country:US
Mailing Address - Phone:732-776-4860
Mailing Address - Fax:732-776-4867
Practice Address - Street 1:61 DAVIS AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4401
Practice Address - Country:US
Practice Address - Phone:732-776-4860
Practice Address - Fax:732-776-4867
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA069259002080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH08321Medicare UPIN
NJ155713UWHMedicare PIN