Provider Demographics
NPI:1912087552
Name:EISENBERG, STUART RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:RICHARD
Last Name:EISENBERG
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 1:10 SHAWNEE DRIVE
Mailing Address - Street 2:SUITE 7A
Mailing Address - City:WATCHING
Mailing Address - State:NJ
Mailing Address - Zip Code:07069
Mailing Address - Country:US
Mailing Address - Phone:908-753-0916
Mailing Address - Fax:908-753-4616
Practice Address - Street 1:10 SHAWNEE DRIVE
Practice Address - Street 2:SUITE 7A
Practice Address - City:WATCHING
Practice Address - State:NJ
Practice Address - Zip Code:07069
Practice Address - Country:US
Practice Address - Phone:908-753-0916
Practice Address - Fax:908-753-4616
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03604000207R00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0776408Medicaid
NJ0776408Medicaid
C54805Medicare UPIN