Provider Demographics
NPI:1578114377
Name:EISENSTEIN, MATTHEW NEWMARK
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:NEWMARK
Last Name:EISENSTEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3260 43RD ST APT 2R
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-2745
Mailing Address - Country:US
Mailing Address - Phone:518-810-7965
Mailing Address - Fax:
Practice Address - Street 1:3260 43RD ST APT 2R
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-2745
Practice Address - Country:US
Practice Address - Phone:518-810-7965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical