Provider Demographics
NPI:1285879015
Name:EISENZOPF, LAURA LOUISE (MS, PT, DPT)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:LOUISE
Last Name:EISENZOPF
Suffix:
Gender:F
Credentials:MS, PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9033 70TH DR
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-6617
Mailing Address - Country:US
Mailing Address - Phone:718-544-0327
Mailing Address - Fax:
Practice Address - Street 1:1 EXPRESSWAY PLZ STE 106
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-2069
Practice Address - Country:US
Practice Address - Phone:516-621-2681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-08
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025794-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist