Provider Demographics
NPI:1073782736
Name:SELIG EISENBERG,M.D., PC.
Entity Type:Organization
Organization Name:SELIG EISENBERG,M.D., PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SELIG
Authorized Official - Middle Name:
Authorized Official - Last Name:EISENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-367-7400
Mailing Address - Street 1:3201 GRAND CONCOURSE APT 1C
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-1226
Mailing Address - Country:US
Mailing Address - Phone:718-367-7400
Mailing Address - Fax:
Practice Address - Street 1:3201 GRAND CONCOURSE APT 1C
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-1226
Practice Address - Country:US
Practice Address - Phone:718-367-7400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY085040174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY085040OtherLICENSE
A100000647OtherMEDICARE PTAN
NY00129511Medicaid
NYAE4478524OtherDEA
NY192981Medicare UPIN