Healthcare Provider Details

I. General information

NPI: 1003044884
Provider Name (Legal Business Name): RACHEL EISENBROCK CHASE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL DANIELLE EISENBROCK DO

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 01/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 COOPER PLZ
CAMDEN NJ
08103-1461
US

IV. Provider business mailing address

1 FEDERAL ST
CAMDEN NJ
08103-1088
US

V. Phone/Fax

Practice location:
  • Phone: 856-342-2000
  • Fax:
Mailing address:
  • Phone: 856-356-4924
  • Fax: 856-356-4793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS014833
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25MB10209900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: