Provider Demographics
NPI:1396280426
Name:EISENSTADT, ANDREW (MS SPECIAL EDUCATION)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:
Last Name:EISENSTADT
Suffix:
Gender:M
Credentials:MS SPECIAL EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196-05A 67TH AVE
Mailing Address - Street 2:APT 3B
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365
Mailing Address - Country:US
Mailing Address - Phone:954-804-8364
Mailing Address - Fax:
Practice Address - Street 1:196-05A 67TH AVE
Practice Address - Street 2:APT 3B
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365
Practice Address - Country:US
Practice Address - Phone:954-804-8364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-28
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY983914685174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist