Provider Demographics
NPI:1265428874
Name:EISEN, DEBORAH IDA (MD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:IDA
Last Name:EISEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 LAKEHURST RD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-8063
Mailing Address - Country:US
Mailing Address - Phone:732-818-9400
Mailing Address - Fax:732-818-0210
Practice Address - Street 1:530 LAKEHURST RD
Practice Address - Street 2:SUITE 306
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-8063
Practice Address - Country:US
Practice Address - Phone:732-818-9400
Practice Address - Fax:732-818-0210
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06408000207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ879993Medicare PIN
NJG30505Medicare UPIN