Provider Demographics
NPI:1891746517
Name:OFFENBACHER, ELIEZER L (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIEZER
Middle Name:L
Last Name:OFFENBACHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2270 KIMBALL ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-5139
Mailing Address - Country:US
Mailing Address - Phone:718-253-6616
Mailing Address - Fax:718-407-1140
Practice Address - Street 1:2270 KIMBALL ST
Practice Address - Street 2:SUITE 102
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5139
Practice Address - Country:US
Practice Address - Phone:718-253-6616
Practice Address - Fax:718-407-1140
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY147975-12085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00897383Medicaid
NY00897383Medicaid
NYB16480Medicare UPIN