Provider Demographics
NPI:1750315883
Name:EISENBERG, EVAN R (MD)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:R
Last Name:EISENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:532 BROADHOLLOW ROAD
Mailing Address - Street 2:SUITE 142
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747
Mailing Address - Country:US
Mailing Address - Phone:516-931-0041
Mailing Address - Fax:
Practice Address - Street 1:4100 DUFF PL
Practice Address - Street 2:SUITE A
Practice Address - City:SEAFORD
Practice Address - State:NY
Practice Address - Zip Code:11783-1324
Practice Address - Country:US
Practice Address - Phone:516-520-8080
Practice Address - Fax:516-520-8877
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY236718208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology