Provider Demographics
NPI:1689018921
Name:EISEMANN, JODY (LAC)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:
Last Name:EISEMANN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:DOROTHY
Other - Middle Name:JO
Other - Last Name:EISEMANN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:284 ANDRASSY AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-4138
Mailing Address - Country:US
Mailing Address - Phone:203-216-2548
Mailing Address - Fax:
Practice Address - Street 1:284 ANDRASSY AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-4138
Practice Address - Country:US
Practice Address - Phone:203-216-2548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT102171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist