Provider Demographics
NPI:1043378425
Name:EISENSTADT, MARVIN (PHD)
Entity type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:
Last Name:EISENSTADT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 S OYSTER BAY ROAD
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-6913
Mailing Address - Country:US
Mailing Address - Phone:516-433-9568
Mailing Address - Fax:
Practice Address - Street 1:352 S OYSTER BAY ROAD
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-6913
Practice Address - Country:US
Practice Address - Phone:516-433-9568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3243103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical