Provider Demographics
NPI:1477815546
Name:AYZENBERG, MARTA
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:
Last Name:AYZENBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1935 SHORE PKWY
Mailing Address - Street 2:APT 13F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-7121
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1935 SHORE PKWY
Practice Address - Street 2:APT 13F
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-7121
Practice Address - Country:US
Practice Address - Phone:347-262-4157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist