Provider Demographics
NPI:1245249978
Name:EITAN, NOAM (MD)
Entity type:Individual
Prefix:DR
First Name:NOAM
Middle Name:
Last Name:EITAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WOODHULL HOSPITAL
Mailing Address - Street 2:760 BROADWAY, PSYCHIATRY, 5TH FL.
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-5317
Mailing Address - Country:US
Mailing Address - Phone:718-963-8628
Mailing Address - Fax:
Practice Address - Street 1:1221 E 14TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-4803
Practice Address - Country:US
Practice Address - Phone:718-535-1956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206352282N00000X, 2084P0800X
283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No282N00000XHospitalsGeneral Acute Care Hospital
No283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01752698Medicaid
NY01752698Medicaid
16X971Medicare ID - Type Unspecified