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Individual

DR. ANDREW S EISEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
168 BEACH 121ST ST, ROCKAWAY PARK, NY 11694-1961
(917) 855-1305
Mailing address
168 BEACH 121ST ST, ROCKAWAY PARK, NY 11694-1961
(917) 855-1305

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
33468
CA
225100000X
Physical Therapist
PT60046366
WA
2251X0800X
Orthopedic Physical Therapist
Primary
036958
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
33468
LICENSE
CA
Enumeration date
02/17/2007
Last updated
12/26/2019
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