Healthcare Provider Details

I. General information

NPI: 1881822880
Provider Name (Legal Business Name): NADINE M EISENBERG O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NADINE M JAMAL O.D.

II. Dates (important events)

Enumeration Date: 06/29/2009
Last Update Date: 09/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

539 PARK AVE
NEW YORK NY
10065-8167
US

IV. Provider business mailing address

539 PARK AVE
NEW YORK NY
10065-8167
US

V. Phone/Fax

Practice location:
  • Phone: 212-758-0772
  • Fax:
Mailing address:
  • Phone: 212-758-0772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberTUV007419-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License NumberTUV007419-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License NumberTUV007419-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: