Provider Demographics
NPI:1639997885
Name:VAISELBERG, SAMUEL JACOB
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:JACOB
Last Name:VAISELBERG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2585 LARCHMONT RD
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-1515
Mailing Address - Country:US
Mailing Address - Phone:786-681-8434
Mailing Address - Fax:
Practice Address - Street 1:2585 LARCHMONT RD
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-1515
Practice Address - Country:US
Practice Address - Phone:786-681-8434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage