Provider Demographics
NPI:1326772062
Name:JIN, EILEEN (MS, SLP, TSSLD)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:JIN
Suffix:
Gender:F
Credentials:MS, SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6308 69TH PL
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-1726
Mailing Address - Country:US
Mailing Address - Phone:718-381-7777
Mailing Address - Fax:
Practice Address - Street 1:6308 69TH PL
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-1726
Practice Address - Country:US
Practice Address - Phone:718-381-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-10
Last Update Date:2023-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program