Provider Demographics
NPI:1396164554
Name:EYZNER, IGOR (DO)
Entity type:Individual
Prefix:
First Name:IGOR
Middle Name:
Last Name:EYZNER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 BERGEN ST.
Mailing Address - Street 2:UH H-245
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103
Mailing Address - Country:US
Mailing Address - Phone:973-972-5672
Mailing Address - Fax:973-972-0365
Practice Address - Street 1:150 BERGEN ST
Practice Address - Street 2:UH H-245
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103
Practice Address - Country:US
Practice Address - Phone:973-972-5672
Practice Address - Fax:973-972-0365
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ25MB10145300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program