Provider Demographics
NPI:1518246768
Name:EISENBERGER, ELIEZER (DPM)
Entity Type:Individual
Prefix:DR
First Name:ELIEZER
Middle Name:
Last Name:EISENBERGER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4915 BROADWAY
Mailing Address - Street 2:SUITE 1J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-3119
Mailing Address - Country:US
Mailing Address - Phone:212-569-5700
Mailing Address - Fax:212-569-5701
Practice Address - Street 1:4915 BROADWAY
Practice Address - Street 2:SUITE 1J
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-3119
Practice Address - Country:US
Practice Address - Phone:212-569-5700
Practice Address - Fax:212-569-5701
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-05
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006432213ES0103X
NJ25MD00323200213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
006432OtherNY STATE LICENSE NUMBER