Provider Demographics
NPI:1407271505
Name:DR.ELIEZER L OFFENBACHER MD, PLLC
Entity type:Organization
Organization Name:DR.ELIEZER L OFFENBACHER MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIEZER
Authorized Official - Middle Name:
Authorized Official - Last Name:OFFENBACHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-743-2300
Mailing Address - Street 1:19 GIRARD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3007
Mailing Address - Country:US
Mailing Address - Phone:718-743-2300
Mailing Address - Fax:
Practice Address - Street 1:3852 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-2013
Practice Address - Country:US
Practice Address - Phone:718-743-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-26
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY147975-32085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty