Provider Demographics
NPI:1134397979
Name:JOHN A ERIANNE M.D P.A.
Entity type:Organization
Organization Name:JOHN A ERIANNE M.D P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES/TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:ERIANNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-656-5263
Mailing Address - Street 1:3285 JFK BLVD
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-4228
Mailing Address - Country:US
Mailing Address - Phone:201-656-5263
Mailing Address - Fax:201-656-3931
Practice Address - Street 1:3285 JFK BLVD
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07307-4228
Practice Address - Country:US
Practice Address - Phone:201-656-5263
Practice Address - Fax:201-656-3931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02314200207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2082306Medicaid
NJ2082306Medicaid