Provider Demographics
NPI:1154209732
Name:EISENBERGER, IAN
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:
Last Name:EISENBERGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 E 3RD ST UNIT 309
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-3549
Mailing Address - Country:US
Mailing Address - Phone:716-228-8974
Mailing Address - Fax:
Practice Address - Street 1:1000 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:ATHERTON
Practice Address - State:CA
Practice Address - Zip Code:94027-4300
Practice Address - Country:US
Practice Address - Phone:716-228-8974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-22
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20000378172081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine