1255316675 NPI number — EUN H SHEEN MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255316675 NPI number — EUN H SHEEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHEEN
Provider First Name:
EUN
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255316675
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
158 LINWOOD PLZ STE 319
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT LEE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07024-3798
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-567-0404
Provider Business Mailing Address Fax Number:
201-482-8856

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
158 LINWOOD PLZ STE 319
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT LEE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07024-3798
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-567-0404
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207K00000X , with the licence number:  25MA03956200 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3469257 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 6N8111 . This is a "EMPIRE BC" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 443282 . This is a "WELLCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2415310000 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 4902844 . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P3239780 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 3428296 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1255316675 . This is a "U.S. FAMILY HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2695794 . This is a "G.H.I. EMBLEM HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3700704 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 60018394 . This is a "HORIZON N.J. HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0115992 . This is a "AMERIGROUP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1255316675 . This is a "TRICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 3469257 . This is a "AETNA HMO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1255316675 . This is a "COVENTRY HEALTH-FIRST HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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