Provider Demographics
NPI:1083944607
Name:HOWARD M. EISENSTODT, M.D., P.A.
Entity Type:Organization
Organization Name:HOWARD M. EISENSTODT, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:EISENSTODT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-376-6400
Mailing Address - Street 1:75 MAIN ST.
Mailing Address - Street 2:SUITE 207
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1322
Mailing Address - Country:US
Mailing Address - Phone:973-376-6400
Mailing Address - Fax:973-376-0797
Practice Address - Street 1:75 MAIN ST.
Practice Address - Street 2:SUITE 207
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1322
Practice Address - Country:US
Practice Address - Phone:973-376-6400
Practice Address - Fax:973-376-0797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-04
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA01690200207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2768402Medicaid
NJ2768402Medicaid
NJ171865Medicare PIN