Provider Demographics
NPI:1134296361
Name:HOWARD EISENBERG MD FCCP LLC
Entity Type:Organization
Organization Name:HOWARD EISENBERG MD FCCP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:EISENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-573-8448
Mailing Address - Street 1:1031 SE 9TH PLACE
Mailing Address - Street 2:UNIT 2
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-3003
Mailing Address - Country:US
Mailing Address - Phone:239-573-8448
Mailing Address - Fax:239-573-8604
Practice Address - Street 1:1031 SE 9TH PLACE
Practice Address - Street 2:UNIT 2
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3003
Practice Address - Country:US
Practice Address - Phone:239-573-8448
Practice Address - Fax:239-573-8604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66815207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DF2856OtherRAILROAD MEDICARE
DF2856OtherRAILROAD MEDICARE