Provider Demographics
NPI:1891830709
Name:EIS, RENIE (PNP)
Entity Type:Individual
Prefix:MS
First Name:RENIE
Middle Name:
Last Name:EIS
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 LANCASTER CT APT B
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-7820
Mailing Address - Country:US
Mailing Address - Phone:973-839-6547
Mailing Address - Fax:
Practice Address - Street 1:4781 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-4915
Practice Address - Country:US
Practice Address - Phone:212-304-6922
Practice Address - Fax:212-304-6924
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY380052363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics