Provider Demographics
NPI:1639469042
Name:EISENBERG, AMY L (FNP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:L
Last Name:EISENBERG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 ARKAY DR STE 230
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-3705
Mailing Address - Country:US
Mailing Address - Phone:833-342-1454
Mailing Address - Fax:
Practice Address - Street 1:80 ARKAY DR STE 230
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-3705
Practice Address - Country:US
Practice Address - Phone:833-342-1454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-19
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF336613-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily