Provider Demographics
NPI:1811929094
Name:LIND, EUGENE JEROME (MD)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:JEROME
Last Name:LIND
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 1:1656 OAK TREE RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2805
Mailing Address - Country:US
Mailing Address - Phone:732-494-6420
Mailing Address - Fax:732-494-5079
Practice Address - Street 1:1656 OAK TREE RD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-2805
Practice Address - Country:US
Practice Address - Phone:732-494-6420
Practice Address - Fax:732-494-5079
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02572400208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
4412711OtherAETNA
L5061OtherOXFORD
898951OtherEMPIRE BS
0077543000OtherAMERIHEALTH
340000304OtherRR MEDICARE
NJ2794900Medicaid
008784OtherONE HEALTH
F13519OtherHEALTH NET
0037221OtherGHI
C53049Medicare UPIN
LI082721Medicare ID - Type Unspecified