Provider Demographics
NPI:1275894305
Name:EIGEN, LORI K
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:K
Last Name:EIGEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15016 24TH RD
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-3624
Mailing Address - Country:US
Mailing Address - Phone:718-757-4712
Mailing Address - Fax:
Practice Address - Street 1:15016 24TH RD
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-3624
Practice Address - Country:US
Practice Address - Phone:718-757-4712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist