Provider Demographics
NPI:1831244003
Name:ETON MEDICAL GROUP, PA
Entity type:Organization
Organization Name:ETON MEDICAL GROUP, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:RUTIGLIANO
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:201-261-6061
Mailing Address - Street 1:1 SEARS DRIVE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652
Mailing Address - Country:US
Mailing Address - Phone:201-261-6061
Mailing Address - Fax:201-261-6465
Practice Address - Street 1:1 SEARS DRIVE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652
Practice Address - Country:US
Practice Address - Phone:201-261-6061
Practice Address - Fax:201-261-6465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
NJMA05433300207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ860736Medicare PIN