Provider Demographics
NPI:1700064896
Name:P. H. EISENFELD, D.P.M., P.A.
Entity Type:Organization
Organization Name:P. H. EISENFELD, D.P.M., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PEPPY
Authorized Official - Middle Name:H
Authorized Official - Last Name:EISENFELD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:561-470-0077
Mailing Address - Street 1:9291 GLADES RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-3959
Mailing Address - Country:US
Mailing Address - Phone:561-470-0077
Mailing Address - Fax:561-470-0079
Practice Address - Street 1:9291 GLADES RD
Practice Address - Street 2:SUITE 305
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-3959
Practice Address - Country:US
Practice Address - Phone:561-470-0077
Practice Address - Fax:561-470-0079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1496332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL87975Medicare PIN
FLT88563Medicare UPIN
FL1126180001Medicare NSC