Provider Demographics
NPI:1184920738
Name:EUGENE JOSEPH LIND MD PA
Entity type:Organization
Organization Name:EUGENE JOSEPH LIND MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:LIND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-736-2290
Mailing Address - Street 1:1001 PLEASANT VALLEY WAY
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1490
Mailing Address - Country:US
Mailing Address - Phone:973-736-2290
Mailing Address - Fax:973-736-0105
Practice Address - Street 1:1001 PLEASANT VALLEY WAY
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1490
Practice Address - Country:US
Practice Address - Phone:973-736-2290
Practice Address - Fax:973-736-0105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-31
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03367600174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC54375Medicare UPIN