Provider Demographics
NPI:1215001623
Name:WACHTER, EILEEN RENEE (MD)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:RENEE
Last Name:WACHTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 E 69TH ST
Mailing Address - Street 2:SUITE 1H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5452
Mailing Address - Country:US
Mailing Address - Phone:212-439-6328
Mailing Address - Fax:212-439-6328
Practice Address - Street 1:219 E 69TH ST
Practice Address - Street 2:SUITE 1H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5452
Practice Address - Country:US
Practice Address - Phone:212-439-6328
Practice Address - Fax:212-439-6328
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1725762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GE44817Medicare UPIN