Provider Demographics
NPI:1013276062
Name:BEAUBRUN, ESIRA JAIMIE (MD)
Entity Type:Individual
Prefix:DR
First Name:ESIRA
Middle Name:JAIMIE
Last Name:BEAUBRUN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 BELLEVILLE AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-3648
Mailing Address - Country:US
Mailing Address - Phone:973-842-4272
Mailing Address - Fax:732-997-3022
Practice Address - Street 1:323 BELLEVILLE AVE FL 2
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-3648
Practice Address - Country:US
Practice Address - Phone:973-842-4272
Practice Address - Fax:732-997-3022
Is Sole Proprietor?:No
Enumeration Date:2012-05-11
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09780500390200000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0532584Medicaid