Basic Information
| Provider Information | |||||||||
| NPI: | 1205826682 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EISENBERG | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1250 | ||||||||
| Address2: | 99 EAST STATE STREET | ||||||||
| City: | GLOVERSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 120780010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187735758 | ||||||||
| FaxNumber: | 5187735456 | ||||||||
| Practice Location | |||||||||
| Address1: | 4104 STATE HIGHWAY 30 | ||||||||
| Address2: | |||||||||
| City: | AMSTERDAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 120106202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5188838624 | ||||||||
| FaxNumber: | 5188838229 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2005 | ||||||||
| LastUpdateDate: | 01/25/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 205839 | NY | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 000000496403 | 01 | NY | PHCS | OTHER | 6502582 | 01 | NY | CIGNA | OTHER | 11589P | 01 | NY | HIP | OTHER | 2096092 | 01 | NY | AETNA HMO | OTHER | 9U9661 | 01 | NY | BC/BS | OTHER | 74-3149469 | 01 | NY | UNITED HEALTH EMPIRE | OTHER | 88522 | 01 | NY | VYTRA | OTHER | ANTHEM | 01 | NY | 020578NY01 | OTHER | 205839-A30 | 01 | NY | HEALTH FIRST | OTHER | 5764669 | 01 | NY | AETNA PPO | OTHER | 01901862 | 05 | NY | MEDICAID | 12-03201 | 01 | NY | UNITED HEALTH CHP | OTHER | 1826218 | 01 | NY | UNITED HEALTH | OTHER | AA50725 | 01 | NY | MDNY | OTHER | ED5839 | 01 | NY | ATLANTIS | OTHER | P1065411 | 01 | NY | OXFORD | OTHER |