Provider Demographics
NPI:1184724957
Name:DAITER, ERIC (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:DAITER
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 1:34-36 PROGRESS ST
Mailing Address - Street 2:SUITE B4
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1197
Mailing Address - Country:US
Mailing Address - Phone:908-226-0250
Mailing Address - Fax:908-226-0830
Practice Address - Street 1:34-36 PROGRESS ST
Practice Address - Street 2:SUITE B4
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-1197
Practice Address - Country:US
Practice Address - Phone:908-226-0250
Practice Address - Fax:908-226-0830
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06037400207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0064156000OtherAMERIHEALTH INSURANCE COM
NJ6175503Medicaid
NJ2K9762OtherHEALTHNET INSURANCE COMPA
NJ505215OtherAETNA INSURANCE COMPANY
NJP748760OtherOXFORD INSURANCE COMPANY
NJ0204670OtherGHI INSURANCE COMPANY
NJMA53294OtherPIN (MDC)
NJDA766331OtherEMPIRE MEDICARE INSURANCE
NJ505215OtherAETNA INSURANCE COMPANY
NJDA766331Medicare ID - Type Unspecified