Provider Demographics
NPI:1538328448
Name:TROTTA, EILEEN (LMT)
Entity Type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:
Last Name:TROTTA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:462 MAGNOLIA BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-1943
Mailing Address - Country:US
Mailing Address - Phone:516-432-1961
Mailing Address - Fax:
Practice Address - Street 1:462 MAGNOLIA BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-1943
Practice Address - Country:US
Practice Address - Phone:516-432-1961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007242225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist