1811905466 NPI number — DR. STEVEN BERNARD EISENSTEIN MD

Table of content: LEE COHEN (NPI 1053792861)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811905466 NPI number — DR. STEVEN BERNARD EISENSTEIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EISENSTEIN
Provider First Name:
STEVEN
Provider Middle Name:
BERNARD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1811905466
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
108 CARSON MILLS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARMVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23901-2728
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-547-5230
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
161 BUSH RIVER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARMVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-392-6455
Provider Business Practice Location Address Fax Number:
434-392-5789
Provider Enumeration Date:
08/03/2006

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: 2084P0800X , with the licence number:  0101054536 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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