Provider Demographics
NPI:1558585406
Name:EISNER, ELLIS A (MA)
Entity type:Individual
Prefix:MS
First Name:ELLIS
Middle Name:A
Last Name:EISNER
Suffix:
Gender:
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 HOMER PL
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-2006
Mailing Address - Country:US
Mailing Address - Phone:718-779-1600
Mailing Address - Fax:718-396-6189
Practice Address - Street 1:339 MAIN ST APT A
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-2490
Practice Address - Country:US
Practice Address - Phone:201-273-8098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist