Provider Demographics
NPI:1649219320
Name:EISENBERG, LEE D (MD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:D
Last Name:EISENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07422-1904
Mailing Address - Country:US
Mailing Address - Phone:201-787-8772
Mailing Address - Fax:
Practice Address - Street 1:115 ISLAND RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07422-1904
Practice Address - Country:US
Practice Address - Phone:201-787-8772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03054400207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB78501Medicare UPIN
NJ1404898Medicare ID - Type Unspecified