MEDICARE: DR. MARK JEFFERY EISENBERG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	166867-01	NY

General Provider Information

NPI Number	:	1679263529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK JEFFERY EISENBERG MD

Provider Business Mailing Address
First Line	:	1303 SUMMIT CIRCLE DR
Second Line	:	ANNA EISENBERG APT
City	:	ROCHESTER
State	:	NY
Zip	:	14618
Country	:	US
Telephone Number	:	514-294-8540
Fax Number	:	514-340-7534

Provider Business Practice Location Address
First Line	:	JEWISH GENERAL HOSPITAL ROOM H421
Second Line	:	3755 COTE ST CATHERINE RD
City	:	MONTREAL
State	:	QC
Zip	:	H4V 2V9
Country	:	CA
Telephone Number	:	514-294-8540
Fax Number	:	514-340-7534

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2023
Last Update Date	:	05/12/2023

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