Healthcare Provider Details

I. General information

NPI: 1316816606
Provider Name (Legal Business Name): THE EAST COAST CENTER FOR COSMETIC BREAST SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2025
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2375 WOODWARD ST STE 102
PHILADELPHIA PA
19115-5105
US

IV. Provider business mailing address

2375 WOODWARD ST STE 102
PHILADELPHIA PA
19115-5105
US

V. Phone/Fax

Practice location:
  • Phone: 215-969-2005
  • Fax: 215-969-2006
Mailing address:
  • Phone: 215-969-2005
  • Fax: 215-969-2006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TED EISENBERG
Title or Position: PRESIDENT
Credential: DO
Phone: 215-969-2005