Healthcare Provider Details

I. General information

NPI: 1245249978
Provider Name (Legal Business Name): NOAM EITAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7116 GRAND AVE
MASPETH NY
11378-1823
US

IV. Provider business mailing address

7116 GRAND AVE
MASPETH NY
11378-1823
US

V. Phone/Fax

Practice location:
  • Phone: 718-551-3770
  • Fax:
Mailing address:
  • Phone: 718-551-3770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number206352
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: