Provider Demographics
NPI:1871611731
Name:EISENBERG, MARK
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:EISENBERG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NS - LIJ -DEPARTMENT OF NEUROSURGERY
Mailing Address - Street 2:900 NORTHERN BOULEVARD
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021
Mailing Address - Country:US
Mailing Address - Phone:516-773-7737
Mailing Address - Fax:
Practice Address - Street 1:NSLIJ -DEPARTMENT OF NEUROSURGERY
Practice Address - Street 2:900 NORTHERN BOULEVARD
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021
Practice Address - Country:US
Practice Address - Phone:516-773-7737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY180342207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery