Individual provider Active NPI

Joseph Eichenbaum, M.D.F.A.C.C.

  • Specialist
  • Lynbrook, NY
National Provider Identifier
1053301267
Registry record updated Mar 24, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
147959 Issued in NY
Practice address
253 Broadway
Lynbrook, NY 11563-3243
Phone
(516) 596-6100
Fax
(516) 599-6989
NPI assigned
Oct 27, 2005
Last updated
Mar 24, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 147959 NY Primary

Addresses

Primary practice location

253 Broadway
Lynbrook, NY 11563-3243

Mailing address

253 Broadway
Lynbrook, NY 11563-3243
Phone (516) 596-6100

Other identifiers 1

IdentifierTypeStateIssuer
00883830MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041206000284 NY Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 6901862564 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
JS Weill Medical College, Cornell University, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1420 Broadway
Hewlett, NY 11557-1321
Phone (516) 764-5455

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore Medical Group of the Mount Sinai School of Medicine Current Accepting new patients
Mount Sinai School of Medicine Current Accepting new patients
Mount Sinai School of Medicine CurrentSince Feb 1, 2019 Accepting new patients
Mount Sinai School of Medicine CurrentSince Feb 1, 2019 Accepting new patients
North Shore Medical Group of the Mount Sinai School of Medicine CurrentSince Jun 1, 2023 Accepting new patients
Franklin Hospital Past Accepting new patients
Icahn School of Medicine at Mount Sinai Past Accepting new patients

Locations

1420 Broadway
Hewlett, NY 11557
Phone (516) 295-1176

325 Park Ave
Huntington, NY 11743
Phone (631) 351-3700

775 Park Ave
Huntington, NY 11743
Phone (631) 396-1595

185 Merrick Rd
Lynbrook, NY 11563
Phone (516) 593-3535

1 Healthy Way
Oceanside, NY 11572
Phone (516) 255-1581

196 Merrick Rd
Oceanside, NY 11572
Phone (516) 255-1616

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1130371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395619200000",
    "number": "1053301267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "253 BROADWAY",
            "city": "LYNBROOK",
            "state": "NY",
            "postal_code": "115633243",
            "telephone_number": "516-596-6100",
            "fax_number": "516-599-6989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "253 BROADWAY",
            "city": "LYNBROOK",
            "state": "NY",
            "postal_code": "115633243",
            "telephone_number": "516-596-6100",
            "fax_number": "516-599-6989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EICHENBAUM",
        "first_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "M.D.F.A.C.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-27",
        "last_updated": "2014-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "147959",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00883830",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lynbrook, NY

Sources for this page

Verify at the official NPI Registry.