Provider Demographics
NPI:1831107358
Name:EISENBERG, KEREN (MAPT)
Entity Type:Individual
Prefix:MRS
First Name:KEREN
Middle Name:
Last Name:EISENBERG
Suffix:
Gender:F
Credentials:MAPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 EXCHANGE PL
Mailing Address - Street 2:SUITE 728
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10005-2701
Mailing Address - Country:US
Mailing Address - Phone:212-425-1060
Mailing Address - Fax:646-527-9021
Practice Address - Street 1:40 EXCHANGE PL
Practice Address - Street 2:SUITE 728
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10005-2701
Practice Address - Country:US
Practice Address - Phone:212-425-1060
Practice Address - Fax:646-527-9021
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0050711225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ18L7Q0241Medicare PIN