Provider Demographics
NPI:1467539254
Name:EISENBERG, MARK (RPT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:EISENBERG
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 LACEY RD
Mailing Address - Street 2:
Mailing Address - City:WHITING
Mailing Address - State:NJ
Mailing Address - Zip Code:08759-2912
Mailing Address - Country:US
Mailing Address - Phone:732-267-7990
Mailing Address - Fax:732-370-1987
Practice Address - Street 1:67 LACEY RD
Practice Address - Street 2:
Practice Address - City:WHITING
Practice Address - State:NJ
Practice Address - Zip Code:08759-2912
Practice Address - Country:US
Practice Address - Phone:732-849-1088
Practice Address - Fax:732-849-1007
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA01668225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist