Healthcare Provider Details

I. General information

NPI: 1447025739
Provider Name (Legal Business Name): VICTORIA EISENBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2023
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 BELL BLVD 3RD FL
BAYSIDE NY
11361
US

IV. Provider business mailing address

1836 ROTARY DR
LOS ANGELES CA
90026-1220
US

V. Phone/Fax

Practice location:
  • Phone: 301-793-1994
  • Fax: 929-480-9701
Mailing address:
  • Phone: 301-793-1994
  • Fax: 929-480-9701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number95017005
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: