Provider Demographics
NPI:1316026503
Name:EISENBERG, ERNIE PAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:ERNIE
Middle Name:PAUL
Last Name:EISENBERG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627A BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-5030
Mailing Address - Country:US
Mailing Address - Phone:516-798-5588
Mailing Address - Fax:516-798-8145
Practice Address - Street 1:627A BROADWAY
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-5030
Practice Address - Country:US
Practice Address - Phone:516-798-5588
Practice Address - Fax:516-798-8145
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005574111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX62481Medicare ID - Type Unspecified