Provider Demographics
NPI:1932238300
Name:EISINGER, JOANN ARENA (PA)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:ARENA
Last Name:EISINGER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JOANN
Other - Middle Name:
Other - Last Name:ARENA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:56-45 MAIN STREET
Mailing Address - Street 2:W-LL300
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5045
Mailing Address - Country:US
Mailing Address - Phone:718-670-1373
Mailing Address - Fax:718-939-1167
Practice Address - Street 1:56-45 MAIN STREET
Practice Address - Street 2:W-LL300
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5045
Practice Address - Country:US
Practice Address - Phone:718-670-1373
Practice Address - Fax:718-939-1167
Is Sole Proprietor?:No
Enumeration Date:2007-03-03
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004560363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY'03610097Medicaid