1619293362 NPI number — TOM A. EISENBERG, PH.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619293362 NPI number — TOM A. EISENBERG, PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOM A. EISENBERG, PH.D.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HUNTINGTON BEHAVIORAL HEALTH
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619293362
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 327
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEMPLE CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91780-0327
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-799-3869
Provider Business Mailing Address Fax Number:
626-768-7490

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2130 HUNTINGTON DR
Provider Second Line Business Practice Location Address:
#306
Provider Business Practice Location Address City Name:
SOUTH PASADENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91030-4964
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-799-3869
Provider Business Practice Location Address Fax Number:
626-768-7490
Provider Enumeration Date:
04/20/2010

Additional Information

Authorized Official

Authorized Official Last Name:
EISENBERG
Authorized Official First Name:
TOM
Authorized Official Middle Name:
ANDREW
Authorized Official Title or Position:
CLINICAL DIRECTOR
Authorized Official Telephone Number:
626-799-3869

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PSY20136 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X , with the licence number: LCS18694 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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