Eisenberg, Ellen

Eisenberg, Ellen is an individual health care provider with primary practice located at 263 Farmington Ave , Farmington CT 06030-0001. She recently has 2 registered licenses in different health care specialties including Dental Providers / General Practice, Dental Providers / Oral and Maxillofacial Pathology. Dental Providers / Oral and Maxillofacial Pathology is her primary health care specialty. Eisenberg, Ellen can be contacted via phone (860) 679-2952.

Contact Information

Primary practice address
263 Farmington Ave Farmington CT 06030-0001
Phone: (860) 679-2952
Fax: (860) 679-4760
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 005451 Connecticut
Dental Providers / Oral and Maxillofacial Pathology 1223P0106X 005451 Connecticut

Profile Details

NPI number 1013913367
LBN Legal business name Eisenberg, Ellen
Credentials Doctor of Dental Medicine (DMD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 22nd, 2005
Last updated Sep 28th, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1013913367 NPPES
Connecticut MEDICAID 2054518

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