Provider Demographics
NPI:1881822880
Name:EISENBERG, NADINE M (OD)
Entity Type:Individual
Prefix:DR
First Name:NADINE
Middle Name:M
Last Name:EISENBERG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:NADINE
Other - Middle Name:M
Other - Last Name:JAMAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:539 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-8167
Mailing Address - Country:US
Mailing Address - Phone:212-758-0772
Mailing Address - Fax:
Practice Address - Street 1:539 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-8167
Practice Address - Country:US
Practice Address - Phone:212-758-0772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV007419-1152WC0802X, 152WV0400X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision