Provider Demographics
NPI:1336416429
Name:ASSANTE, EILEEN TERESA (LMT)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:TERESA
Last Name:ASSANTE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 FIELD CT
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-5346
Mailing Address - Country:US
Mailing Address - Phone:516-965-7007
Mailing Address - Fax:516-513-1051
Practice Address - Street 1:2 FIELD CT
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-5346
Practice Address - Country:US
Practice Address - Phone:516-965-7007
Practice Address - Fax:516-513-1051
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023539225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist