Provider Demographics
NPI:1205826682
Name:EISENBERG, DAVID J (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:EISENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1250
Mailing Address - Street 2:99 EAST STATE STREET
Mailing Address - City:GLOVERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12078-0010
Mailing Address - Country:US
Mailing Address - Phone:518-773-5758
Mailing Address - Fax:518-773-5456
Practice Address - Street 1:4104 STATE HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-6202
Practice Address - Country:US
Practice Address - Phone:518-883-8624
Practice Address - Fax:518-883-8229
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY205839208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000000496403OtherPHCS
NY6502582OtherCIGNA
NY11589POtherHIP
NY2096092OtherAETNA HMO
NY9U9661OtherBC/BS
NY74-3149469OtherUNITED HEALTH EMPIRE
NY88522OtherVYTRA
NYANTHEMOther020578NY01
NY205839-A30OtherHEALTH FIRST
NY5764669OtherAETNA PPO
NY01901862Medicaid
NY12-03201OtherUNITED HEALTH CHP
NY1826218OtherUNITED HEALTH
NYAA50725OtherMDNY
NYED5839OtherATLANTIS
NYP1065411OtherOXFORD