Provider Demographics
NPI:1598109217
Name:EISENSTADT, ASHLEY JORDAN (MS, CCC-SLP, TSSLD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:JORDAN
Last Name:EISENSTADT
Suffix:
Gender:F
Credentials:MS, CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E 55TH ST
Mailing Address - Street 2:APT. 2G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-5133
Mailing Address - Country:US
Mailing Address - Phone:516-698-4610
Mailing Address - Fax:
Practice Address - Street 1:134 W 26TH ST
Practice Address - Street 2:SUITE #602
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6803
Practice Address - Country:US
Practice Address - Phone:212-604-9360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-24
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022451-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist