Provider Demographics
NPI:1619319423
Name:EISEN, JANE LORI
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:LORI
Last Name:EISEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 W 23RD ST
Mailing Address - Street 2:APT. 5C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-2172
Mailing Address - Country:US
Mailing Address - Phone:917-270-2656
Mailing Address - Fax:
Practice Address - Street 1:500 BI COUNTY BLVD STE 114
Practice Address - Street 2:FARMINGDALE
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-3931
Practice Address - Country:US
Practice Address - Phone:516-753-6507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY09564481235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist