Provider Demographics
NPI:1285715912
Name:EISENFELD, P H (DPM)
Entity type:Individual
Prefix:
First Name:P
Middle Name:H
Last Name:EISENFELD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:PEPPY
Other - Middle Name:H
Other - Last Name:EISENFELD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:9291 GLADES RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-3959
Mailing Address - Country:US
Mailing Address - Phone:561-470-0077
Mailing Address - Fax:561-470-0079
Practice Address - Street 1:9291 GLADES RD
Practice Address - Street 2:SUITE 305
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-3959
Practice Address - Country:US
Practice Address - Phone:561-470-0077
Practice Address - Fax:561-470-0079
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO-1496213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT88563Medicare UPIN
FL87875Medicare PIN