Provider Demographics
NPI:1982281366
Name:RIFKIN, EILEEN
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:RIFKIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4613 TUCSON CT
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33594-9315
Mailing Address - Country:US
Mailing Address - Phone:813-408-3089
Mailing Address - Fax:
Practice Address - Street 1:3100 MONTICELLO AVE # 210
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-3442
Practice Address - Country:US
Practice Address - Phone:817-529-8514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
1111111111OtherNOT APPLICABLE