Provider Demographics
NPI:1568135416
Name:EILBOTT, DENISE PEARL (MASTERS)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:PEARL
Last Name:EILBOTT
Suffix:
Gender:F
Credentials:MASTERS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 TERRACE BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-4322
Mailing Address - Country:US
Mailing Address - Phone:516-662-8259
Mailing Address - Fax:
Practice Address - Street 1:316 TERRACE BLVD
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-4322
Practice Address - Country:US
Practice Address - Phone:516-662-8259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty