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General NPI Number Information
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NPI Number | 1154209732
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Entity Type | Individual
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Provider Name | IAN EISENBERGER
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Gender | Male
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Dates
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Enumeration Date | 08/22/2025
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Last Update Date | 08/22/2025
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Provider Practice Location Address
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Address Line | 1000 EL CAMINO REAL
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City | ATHERTON
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State | CA
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Zip | 94027-4300
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Country | US
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Telephone | 716-228-8974
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Fax |
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Provider Business Mailing Address
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Address Line | 90 E 3RD ST UNIT 309
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City | MORGAN HILL
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State | CA
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Zip | 95037-3549
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Country | US
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Telephone | 716-228-8974
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 2000037817
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License Number State | NY
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