Basic Information
| Provider Information | |||||||||
| NPI: | 1053401794 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | IZENBERG | ||||||||
| FirstName: | NEIL | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | CORPORATE CREDENTIALING | ||||||||
| Address2: | P.O. BOX 269 | ||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 19899 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026515938 | ||||||||
| FaxNumber: | 3026516077 | ||||||||
| Practice Location | |||||||||
| Address1: | A.I. DUPONT HOSPITAL FOR CHILDREN | ||||||||
| Address2: | 1600 ROCKLAND ROAD | ||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 19899 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026514000 | ||||||||
| FaxNumber: | 3026514945 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080A0000X | C10003991 | DE | Y | Allopathic & Osteopathic Physicians | Pediatrics | Adolescent Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0689117 (PA) | 05 | DE | MEDICAID |