Provider Demographics
NPI:1366768319
Name:EISNY OT/PT/SLP PLLC
Entity type:Organization
Organization Name:EISNY OT/PT/SLP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MANJUSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHRA
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:914-373-6520
Mailing Address - Street 1:PO BOX 441
Mailing Address - Street 2:
Mailing Address - City:SOMERS
Mailing Address - State:NY
Mailing Address - Zip Code:10589-0441
Mailing Address - Country:US
Mailing Address - Phone:914-373-6520
Mailing Address - Fax:914-373-6521
Practice Address - Street 1:189 ROUTE 100
Practice Address - Street 2:
Practice Address - City:SOMERS
Practice Address - State:NY
Practice Address - Zip Code:10589-2811
Practice Address - Country:US
Practice Address - Phone:914-373-6520
Practice Address - Fax:914-373-6521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-15
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25296252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency