Provider Demographics
NPI:1730451824
Name:EISENBERG, LAURA (LPN)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:EISENBERG
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:373 BROADWAY
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-2707
Mailing Address - Country:US
Mailing Address - Phone:631-608-8523
Mailing Address - Fax:
Practice Address - Street 1:373 BROADWAY
Practice Address - Street 2:2ND FLOOR
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2707
Practice Address - Country:US
Practice Address - Phone:631-608-8523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-03
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY293217164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse