Provider Demographics
NPI:1922706373
Name:EISEN, LINDA SEGAL
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:SEGAL
Last Name:EISEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:447 35TH ST
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-2647
Mailing Address - Country:US
Mailing Address - Phone:631-948-1443
Mailing Address - Fax:
Practice Address - Street 1:447 35TH ST
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-2647
Practice Address - Country:US
Practice Address - Phone:631-948-1443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency