Provider Demographics
NPI:1700968278
Name:EISENBERG, DAVID EVAN (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:EVAN
Last Name:EISENBERG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 E 46TH ST
Mailing Address - Street 2:APT 5K
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-3036
Mailing Address - Country:US
Mailing Address - Phone:718-229-8770
Mailing Address - Fax:718-747-2967
Practice Address - Street 1:310 E 46TH ST
Practice Address - Street 2:APT 5K
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-3036
Practice Address - Country:US
Practice Address - Phone:718-229-8770
Practice Address - Fax:718-747-2967
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2017-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011023111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07579Medicare ID - Type Unspecified