Basic Information
| Provider Information | |||||||||
| NPI: | 1689602229 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EISENBERG | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | AARON | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 CAPITAL WAY STE 356 | ||||||||
| Address2: | |||||||||
| City: | PENNINGTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 085342521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6095376000 | ||||||||
| FaxNumber: | 6095376002 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 CAPITAL WAY STE 356 | ||||||||
| Address2: | |||||||||
| City: | PENNINGTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 085342521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6095376000 | ||||||||
| FaxNumber: | 6095376002 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2006 | ||||||||
| LastUpdateDate: | 04/26/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 2006-00595 | NC | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0129X | 2006-00595 | NC | N | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 208600000X | 25MA09093500 | NJ | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | CB8658 | 01 | RR GROUP | OTHER | 5903937 | 05 | NC | MEDICAID | P00328218 | 01 | RR MEDICARE | OTHER | 0200492 | 05 | NJ | MEDICAID | 1023029430001 | 05 | PA | MEDICAID |