Provider Demographics
NPI:1174541197
Name:EISENBERG, EDWARD ADAM (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:ADAM
Last Name:EISENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:EASY
Other - Middle Name:EDDIE
Other - Last Name:EISENBERG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5 MAPLE STREET
Mailing Address - Street 2:NORWALK HOSPITAL
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06856
Mailing Address - Country:US
Mailing Address - Phone:203-852-2281
Mailing Address - Fax:
Practice Address - Street 1:24 MAPLE ST
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850-3815
Practice Address - Country:US
Practice Address - Phone:203-852-2281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT038832146D00000X
CT38832207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT38832Other38832