Active NPI
Gail C Eisenberg, M.D.
- Psychiatry Physician
- Hollywood, FL
National Provider Identifier
1215113253
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 40872
- Practice address
- 3990 Sheridan St
Suite 204
Hollywood, FL 33021-3661 - Phone
- (954) 964-9242
- Fax
- (954) 964-9279
- NPI assigned
- Jan 20, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 40872 | FL | Primary |
Addresses
Primary practice location
3990 Sheridan St
Suite 204
Hollywood, FL 33021-3661
Mailing address
3990 Sheridan St
Suite 204
Hollywood, FL 33021-3661
Phone (954) 964-9242
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective May 7, 2019 through May 7, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 40872 | FL | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1200787200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1200787200000",
"number": "1215113253",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3990 SHERIDAN ST",
"address_2": "SUITE 204",
"city": "HOLLYWOOD",
"state": "FL",
"postal_code": "330213661",
"telephone_number": "954-964-9242",
"fax_number": "954-964-9279"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3990 SHERIDAN ST",
"address_2": "SUITE 204",
"city": "HOLLYWOOD",
"state": "FL",
"postal_code": "330213661",
"telephone_number": "954-964-9242",
"fax_number": "954-964-9279"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EISENBERG",
"first_name": "GAIL",
"middle_name": "C",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-01-20",
"last_updated": "2008-01-20",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "FL",
"license": "40872",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hollywood, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.