Provider Demographics
NPI:1386770428
Name:EISENBERG, TED (DO)
Entity type:Individual
Prefix:DR
First Name:TED
Middle Name:
Last Name:EISENBERG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2375 WOODWARD ST
Mailing Address - Street 2:102
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-5120
Mailing Address - Country:US
Mailing Address - Phone:215-969-2005
Mailing Address - Fax:215-969-2006
Practice Address - Street 1:2375 WOODWARD ST
Practice Address - Street 2:102
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-5120
Practice Address - Country:US
Practice Address - Phone:215-969-2005
Practice Address - Fax:215-969-2006
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004048L2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery