Provider Demographics
NPI:1285790758
Name:EISIKOWITZ, LEON B (MD)
Entity type:Individual
Prefix:DR
First Name:LEON
Middle Name:B
Last Name:EISIKOWITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:LEON
Other - Middle Name:B
Other - Last Name:EISIKOWITZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:8015 164TH ST
Mailing Address - Street 2:1ST FLOOR LEFT
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-1116
Mailing Address - Country:US
Mailing Address - Phone:718-544-9049
Mailing Address - Fax:718-544-2237
Practice Address - Street 1:8015 164TH ST
Practice Address - Street 2:1SR FLOOR LEFT
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-1116
Practice Address - Country:US
Practice Address - Phone:718-544-9049
Practice Address - Fax:718-544-2237
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY164424207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01130478Medicaid
NYD91949Medicare UPIN
NY10671GMedicare PIN