Provider Demographics
NPI:1346431897
Name:WITZENBURG, ERIC NATHANIEL (OD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:NATHANIEL
Last Name:WITZENBURG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:381 AMSTERDAM AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-6266
Mailing Address - Country:US
Mailing Address - Phone:212-724-8855
Mailing Address - Fax:
Practice Address - Street 1:381 AMSTERDAM AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6266
Practice Address - Country:US
Practice Address - Phone:212-724-8855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3103000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist