Provider Demographics
NPI:1205434248
Name:EISENMAN, AVRAHAM Y (FNP)
Entity type:Individual
Prefix:
First Name:AVRAHAM
Middle Name:Y
Last Name:EISENMAN
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 PASSAIC AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-1847
Mailing Address - Country:US
Mailing Address - Phone:201-463-8933
Mailing Address - Fax:
Practice Address - Street 1:706 PASSAIC AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-1847
Practice Address - Country:US
Practice Address - Phone:201-463-8933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-12
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01066600363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily