Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | MB4663 | NJ |
NPI | 1134104516 |
---|---|
Provider Name | Dr. Steven Alan Eisenstat |
First Address | Boston, MA 02241-6457 |
Second Address | Union, NJ 07083-7983 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2005 |
Last Update Date | 01/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C52662 | (02) | NJ |