Provider Demographics
NPI:1801165600
Name:ECKSTEIN, JENNIFER ALYSE (MA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ALYSE
Last Name:ECKSTEIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 WOODMERE BLVD S
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1821
Mailing Address - Country:US
Mailing Address - Phone:516-374-0276
Mailing Address - Fax:
Practice Address - Street 1:1221 E 14TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-4803
Practice Address - Country:US
Practice Address - Phone:718-535-1958
Practice Address - Fax:718-535-2078
Is Sole Proprietor?:No
Enumeration Date:2011-12-22
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021586235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist