Individual
NICHOLAS Y EISENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
224 W D.L. INGRAM AVE, BLDG 1408, CANNON AFB, NM 88103-5103
(575) 681-3917
Mailing address
224 W D.L. INGRAM AVE, BLDG 1408, CANNON AFB, NM 88103-5103
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
35.146152
OH
207R00000X
Internal Medicine Physician
MD2024-0097
NM
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
01/16/2020
Last updated
06/17/2025
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