1013006915 NPI number — DR. ENA ALYESE MARSAN D.O.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013006915 NPI number — DR. ENA ALYESE MARSAN D.O.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

MARSAN

Provider First Name:

ENA

Provider Middle Name:

ALYESE

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

D.O.

Provider Gender Code:

F

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:

1013006915

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

10/25/2022

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

466 OLD HOOK RD STE 1

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

EMERSON

Provider Business Mailing Address State Name:

NJ

Provider Business Mailing Address Postal Code:

07630-1368

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

201-967-8221

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

1 W RIDGEWOOD AVE STE 211

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

PARAMUS

Provider Business Practice Location Address State Name:

NJ

Provider Business Practice Location Address Postal Code:

07652-2361

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

201-251-2323

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

10/11/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207V00000X , with the licence number:  242519 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207V00000X , with the licence number: 25MB07969500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 2624630 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 41114 . This is a "UHP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 60017939 . This is a "HORIXON NJ HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 91001907701 . This is a "AMERICHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 25MB07969500BNE . This is a "HEALTH FIRST" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 222290124A . This is a "HORIZON BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 0103268 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
• Identifier: 9652165 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 01130438 . This is a "AMERIGROUP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".