Healthcare Provider Details

I. General information

NPI: 1881703452
Provider Name (Legal Business Name): MICHAEL L EISENBERG MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 NORTHERN BLVD SUITE 302
GREAT NECK NY
11021-5309
US

IV. Provider business mailing address

935 NORTHERN BLVD SUITE 302
GREAT NECK NY
11021-5309
US

V. Phone/Fax

Practice location:
  • Phone: 516-487-6163
  • Fax: 516-829-3912
Mailing address:
  • Phone: 516-487-6163
  • Fax: 516-829-3912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number139536
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: