Provider Demographics
NPI:1730192691
Name:DRISCOLL, ERIC JOSEPH (DO)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:JOSEPH
Last Name:DRISCOLL
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 1:707 WHITE HORSE PIKE STE C1
Mailing Address - Street 2:
Mailing Address - City:ABSECON
Mailing Address - State:NJ
Mailing Address - Zip Code:08201-1461
Mailing Address - Country:US
Mailing Address - Phone:609-813-2200
Mailing Address - Fax:609-813-2201
Practice Address - Street 1:707 WHITE HORSE PIKE STE C1
Practice Address - Street 2:
Practice Address - City:ABSECON
Practice Address - State:NJ
Practice Address - Zip Code:08201-1461
Practice Address - Country:US
Practice Address - Phone:609-813-2200
Practice Address - Fax:609-813-2201
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07015200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ037985Medicare ID - Type Unspecified
NJH14682Medicare UPIN