Provider Demographics
NPI:1356543284
Name:TEIRSTEIN, EVA (ATR-BC,LCAT)
Entity type:Individual
Prefix:MS
First Name:EVA
Middle Name:
Last Name:TEIRSTEIN
Suffix:
Gender:F
Credentials:ATR-BC,LCAT
Other - Prefix:
Other - First Name:EVA
Other - Middle Name:TEIRSTEIN
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1540 YORK AVE
Mailing Address - Street 2:OFFICE SUITE #1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-5962
Mailing Address - Country:US
Mailing Address - Phone:212-717-6077
Mailing Address - Fax:
Practice Address - Street 1:1540 YORK AVE
Practice Address - Street 2:OFFICE SUITE #1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-5962
Practice Address - Country:US
Practice Address - Phone:212-717-6077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000520-1221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist