Healthcare Provider Details

I. General information

NPI: 1366504862
Provider Name (Legal Business Name): DRS EISENBERG OF PRINCETON JCT PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 ALEXANDER ROAD
PRINCETON NJ
08540
US

IV. Provider business mailing address

710 ALEXANDER ROAD
PRINCETON NJ
08540
US

V. Phone/Fax

Practice location:
  • Phone: 609-520-0404
  • Fax: 609-520-8508
Mailing address:
  • Phone: 609-520-0404
  • Fax: 609-520-8508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number16568
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number16495
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number16220
License Number StateNJ

VIII. Authorized Official

Name: MATTHEW C EISENBERG
Title or Position: DENTIST
Credential:
Phone: 609-520-0404