Healthcare Provider Details

I. General information

NPI: 1558272724
Provider Name (Legal Business Name): MEGED EISENBERG LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20000 HORIZON WAY STE 120
MOUNT LAUREL NJ
08054-4303
US

IV. Provider business mailing address

20000 HORIZON WAY STE 120
MOUNT LAUREL NJ
08054-4303
US

V. Phone/Fax

Practice location:
  • Phone: 856-269-0019
  • Fax: 856-497-2525
Mailing address:
  • Phone: 856-269-0019
  • Fax: 856-497-2525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00740800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: