Provider Demographics
NPI:1174980775
Name:EISEN, ANDREW (PHD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:EISEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:ANDREW
Other - Middle Name:R
Other - Last Name:EISEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:119 FIRST ST STE 1
Mailing Address - Street 2:
Mailing Address - City:HO HO KUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07423-1576
Mailing Address - Country:US
Mailing Address - Phone:201-692-2593
Mailing Address - Fax:
Practice Address - Street 1:119 FIRST ST STE 1
Practice Address - Street 2:
Practice Address - City:HO HO KUS
Practice Address - State:NJ
Practice Address - Zip Code:07423-1576
Practice Address - Country:US
Practice Address - Phone:201-692-2593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-27
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100343000103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical