Basic Information
| Provider Information | |||||||||
| NPI: | 1013006915 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARSAN | ||||||||
| FirstName: | ENA | ||||||||
| MiddleName: | ALYESE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 466 OLD HOOK RD STE 1 | ||||||||
| Address2: | |||||||||
| City: | EMERSON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076301368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2019678221 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1 W RIDGEWOOD AVE STE 211 | ||||||||
| Address2: | |||||||||
| City: | PARAMUS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076522361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2012512323 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2006 | ||||||||
| LastUpdateDate: | 10/25/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 242519 | NY | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 25MB07969500 | NJ | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 2624630 | 01 | NJ | UNITED HEALTH CARE | OTHER | 41114 | 01 | NJ | UHP | OTHER | 60017939 | 01 | NJ | HORIXON NJ HEALTH | OTHER | 91001907701 | 01 | NJ | AMERICHOICE | OTHER | 25MB07969500BNE | 01 | NJ | HEALTH FIRST | OTHER | 222290124A | 01 | NJ | HORIZON BLUE CROSS/BLUE SHIELD | OTHER | 0103268 | 05 | NJ | MEDICAID | 9652165 | 01 | NJ | AETNA | OTHER | 01130438 | 01 | NJ | AMERIGROUP | OTHER |