Provider Demographics
NPI:1588734826
Name:SOLJANICH, EILEEN (PT)
Entity type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:
Last Name:SOLJANICH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 RIVERHEAD RD
Mailing Address - Street 2:
Mailing Address - City:WESTHAMPTON BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11978-1401
Mailing Address - Country:US
Mailing Address - Phone:631-288-7767
Mailing Address - Fax:631-288-7100
Practice Address - Street 1:74 RIVERHEAD RD
Practice Address - Street 2:
Practice Address - City:WESTHAMPTON BEACH
Practice Address - State:NY
Practice Address - Zip Code:11978-1401
Practice Address - Country:US
Practice Address - Phone:631-288-7767
Practice Address - Fax:631-288-7100
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015752-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQH5051OtherBC-BS
NY32803OtherCIGNA
NYAZ00175OtherMDNY
NY32803OtherUS FAMILY HEALTH
NY6698019OtherGHI
NY00274406Medicaid
NY015752-A64OtherHEALTHFIRST
NY2365871OtherAETNA
NY58418OtherVYTRA
NY6698019OtherGHI