Provider Demographics
NPI:1417283409
Name:EISEN, ALIZA VAZANA (DPM)
Entity type:Individual
Prefix:DR
First Name:ALIZA
Middle Name:VAZANA
Last Name:EISEN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:MISS
Other - First Name:ALIZA
Other - Middle Name:
Other - Last Name:VAZANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:39 RITTENHOUSE PL
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-2209
Mailing Address - Country:US
Mailing Address - Phone:610-642-8837
Mailing Address - Fax:610-642-1607
Practice Address - Street 1:39 RITTENHOUSE PL
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:PA
Practice Address - Zip Code:19003-2209
Practice Address - Country:US
Practice Address - Phone:610-642-8837
Practice Address - Fax:610-642-1607
Is Sole Proprietor?:No
Enumeration Date:2009-10-26
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006113213EP1101X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine