1205826682 NPI number — DR. DAVID J EISENBERG M.D.

Table of content: DR. DAVID J EISENBERG M.D. (NPI 1205826682)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205826682 NPI number — DR. DAVID J EISENBERG M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EISENBERG
Provider First Name:
DAVID
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1205826682
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/25/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1250
Provider Second Line Business Mailing Address:
99 EAST STATE STREET
Provider Business Mailing Address City Name:
GLOVERSVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12078-0010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-773-5758
Provider Business Mailing Address Fax Number:
518-773-5456

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4104 STATE HIGHWAY 30
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMSTERDAM
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12010-6202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-883-8624
Provider Business Practice Location Address Fax Number:
518-883-8229
Provider Enumeration Date:
10/26/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  205839 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000496403 . This is a "PHCS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6502582 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 11589P . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2096092 . This is a "AETNA HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 9U9661 . This is a "BC/BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 74-3149469 . This is a "UNITED HEALTH EMPIRE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 88522 . This is a "VYTRA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: ANTHEM . This is a "020578NY01" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 205839-A30 . This is a "HEALTH FIRST" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5764669 . This is a "AETNA PPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01901862 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 12-03201 . This is a "UNITED HEALTH CHP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1826218 . This is a "UNITED HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: AA50725 . This is a "MDNY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: ED5839 . This is a "ATLANTIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P1065411 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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