Provider Demographics
NPI:1619978194
Name:EISENBERG, LAWRENCE B (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:B
Last Name:EISENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1201 NOTT ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12308-2589
Mailing Address - Country:US
Mailing Address - Phone:518-374-3123
Mailing Address - Fax:518-374-9711
Practice Address - Street 1:1201 NOTT ST
Practice Address - Street 2:SUITE 106
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-2589
Practice Address - Country:US
Practice Address - Phone:518-374-3123
Practice Address - Fax:518-374-9711
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104055-1207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000410990001OtherBLUE SHIELD NENY
104055-1OtherTRICARE NORTH REGION
28481OtherEMPIRE BLUE CROSS
NY00392856Medicaid
10000562OtherCDPHP
9711439OtherGHI
CAN1040559OtherNO FAULT
LE02848110OtherEMPIRE BLUE CROSS
LE02848120OtherEMPIRE BLUE CROSS
05105OtherMVP
D01977OtherAMERICAN PROGRESSIVE TODA
040426006662OtherFIDELIS
CAN1040559OtherWORKERS COMP
000410990003OtherBLUE SHIELD NENY
33570JOtherFIDELIS MEDICARE
000000091607OtherGHI HMO
110160500OtherUS DEPT OF LABOR
LE02848120OtherEMPIRE BLUE CROSS
33570JMedicare ID - Type Unspecified
CAN1040559OtherNO FAULT