Provider Demographics
NPI:1447395991
Name:EASTERN, JOSEPH SHELDON (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:SHELDON
Last Name:EASTERN
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 1:36 NEWARK AVE
Mailing Address - Street 2:SUITE 214
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-4119
Mailing Address - Country:US
Mailing Address - Phone:973-751-1200
Mailing Address - Fax:973-450-9395
Practice Address - Street 1:36 NEWARK AVE
Practice Address - Street 2:SUITE 214
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-4119
Practice Address - Country:US
Practice Address - Phone:973-751-1200
Practice Address - Fax:973-450-9395
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03902100174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ48274OtherAETNA HEALTH PLANS
NJES104OtherOXFORD HEALTH PLANS
NJ526858Medicare ID - Type Unspecified
NJ48274OtherAETNA HEALTH PLANS