Healthcare Provider Details

I. General information

NPI: 1689202202
Provider Name (Legal Business Name): ELI SAMUEL NEUSTADTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BROOKLINE AVE
BOSTON MA
02215-5491
US

IV. Provider business mailing address

330 BROOKLINE AVE
BOSTON MA
02215-5491
US

V. Phone/Fax

Practice location:
  • Phone: 617-667-4654
  • Fax:
Mailing address:
  • Phone: 617-667-4654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number1023528
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number1023528
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: