Provider Demographics
NPI:1689683591
Name:EISENBERG, PHILIP (PHD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:
Last Name:EISENBERG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 EXECUTIVE DR.
Mailing Address - Street 2:SUITE LL107
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803
Mailing Address - Country:US
Mailing Address - Phone:631-455-7258
Mailing Address - Fax:
Practice Address - Street 1:255 EXECUTIVE DR.
Practice Address - Street 2:SUITE LL107
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803
Practice Address - Country:US
Practice Address - Phone:631-455-7258
Practice Address - Fax:888-972-9445
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY16639103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist