Provider Demographics
NPI:1609010040
Name:EISENBERG POLLAK, JUDITH (MA)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:
Last Name:EISENBERG POLLAK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 W END AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-8106
Mailing Address - Country:US
Mailing Address - Phone:212-362-6714
Mailing Address - Fax:
Practice Address - Street 1:290 W END AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-8106
Practice Address - Country:US
Practice Address - Phone:917-494-2811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003890-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist