Healthcare Provider Details

I. General information

NPI: 1124933569
Provider Name (Legal Business Name): MARC EICHENBAUM DR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

4473 SILSBY RD
UNIVERSITY HEIGHTS OH
44118-3938
US

IV. Provider business mailing address

4473 SILSBY RD
UNIVERSITY HEIGHTS OH
44118-3938
US

V. Phone/Fax

Practice location:
  • Phone: 516-524-3713
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberP.09018
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number028396
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: