Provider Demographics
NPI:1942804547
Name:EISENBERG, BRENNA MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:BRENNA
Middle Name:MARIE
Last Name:EISENBERG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 GENESEE ST STE C
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:NY
Mailing Address - Zip Code:13421-2644
Mailing Address - Country:US
Mailing Address - Phone:315-361-2377
Mailing Address - Fax:315-361-2978
Practice Address - Street 1:301 GENESEE ST STE C
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421-2644
Practice Address - Country:US
Practice Address - Phone:315-361-2377
Practice Address - Fax:315-361-2978
Is Sole Proprietor?:No
Enumeration Date:2020-11-24
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06422857Medicaid