Provider Demographics
NPI:1891778353
Name:EISENBERG, SCOTT R (DO)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:R
Last Name:EISENBERG
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1944 CORLIES AVE
Mailing Address - Street 2:STE 207
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-4862
Mailing Address - Country:US
Mailing Address - Phone:732-774-2330
Mailing Address - Fax:732-774-1882
Practice Address - Street 1:2130 HIGHWAY 35
Practice Address - Street 2:BLDG C STE 321
Practice Address - City:SEA GIRT
Practice Address - State:NJ
Practice Address - Zip Code:08750-1010
Practice Address - Country:US
Practice Address - Phone:732-974-6700
Practice Address - Fax:732-974-6707
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2008-04-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB06606100207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8207003Medicaid
NJ008853W7NMedicare PIN
F81660Medicare UPIN