Provider Demographics
NPI:1104914084
Name:ESFORMES, IRA (MD)
Entity type:Individual
Prefix:DR
First Name:IRA
Middle Name:
Last Name:ESFORMES
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 1:440 OLD HOOK RD
Mailing Address - Street 2:
Mailing Address - City:EMERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07630-2302
Mailing Address - Country:US
Mailing Address - Phone:201-358-0707
Mailing Address - Fax:201-358-9777
Practice Address - Street 1:440 OLD HOOK RD
Practice Address - Street 2:
Practice Address - City:EMERSON
Practice Address - State:NJ
Practice Address - Zip Code:07630-2302
Practice Address - Country:US
Practice Address - Phone:201-358-0707
Practice Address - Fax:201-358-9777
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41635207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
008755OtherAETNA
77G53OtherEMPIRE B/C B/S
F13771Medicare UPIN