Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 228624 | MA |
Y | 2080P0204X | Pediatric Emergency Doctor | 238699 | MA |
NPI | 1184891566 |
---|---|
Provider Name | Dr. Matthew Eisenberg |
First Address | Newton, MA 02461-1824 |
Second Address | Boston, MA 02115-5724 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2008 |
Last Update Date | 20/08/2015 |