Provider Demographics
NPI:1689904526
Name:RODRIGUEZ-EISENBERG, LOURDES (MS, RD, CDN)
Entity Type:Individual
Prefix:MRS
First Name:LOURDES
Middle Name:
Last Name:RODRIGUEZ-EISENBERG
Suffix:
Gender:F
Credentials:MS, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 CELLER AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2058
Mailing Address - Country:US
Mailing Address - Phone:516-270-3879
Mailing Address - Fax:516-216-5749
Practice Address - Street 1:165 CELLER AVE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-2058
Practice Address - Country:US
Practice Address - Phone:516-270-3879
Practice Address - Fax:516-216-5749
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-27
Last Update Date:2009-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005805-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered