Provider Demographics
NPI:1801873518
Name:AISENBERG, JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:AISENBERG
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:PO BOX 780217
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-0217
Mailing Address - Country:US
Mailing Address - Phone:718-639-8827
Mailing Address - Fax:718-639-8811
Practice Address - Street 1:311 E 79TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-0903
Practice Address - Country:US
Practice Address - Phone:212-996-6633
Practice Address - Fax:212-996-6677
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY176529207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNS1696OtherOXFORD HEALTH PLAN
NY2C3408OtherHEALTHNET OF NEWYORK,INC.
NYE87545Medicare UPIN
NY77F92Medicare PIN