Provider Demographics
NPI:1063573616
Name:ENRIQUEZ, EDUARDO FRANCISCO (MD)
Entity type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:FRANCISCO
Last Name:ENRIQUEZ
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 1:1415 MARLTON PIKE E STE LL5
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-2229
Mailing Address - Country:US
Mailing Address - Phone:856-285-7200
Mailing Address - Fax:856-285-7201
Practice Address - Street 1:3 BRENDENWOOD DR
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-1603
Practice Address - Country:US
Practice Address - Phone:856-874-0202
Practice Address - Fax:856-874-0220
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05198500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ381020OtherMEDICARE GROUP
NJ0455091OtherMEDICAID GROUP
NJ0455091OtherMEDICAID GROUP
E39383Medicare UPIN
NJ597515ZK8MMedicare PIN