Provider Demographics
NPI:1902968399
Name:EISEN, SUSAN R (DC)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:R
Last Name:EISEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 W. 36TH ST.
Mailing Address - Street 2:FL 2
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-8776
Mailing Address - Country:US
Mailing Address - Phone:212-213-2273
Mailing Address - Fax:973-316-8351
Practice Address - Street 1:150 W. 36TH ST
Practice Address - Street 2:FL. 2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-8776
Practice Address - Country:US
Practice Address - Phone:212-213-2273
Practice Address - Fax:212-684-6776
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007005-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY222752039OtherEIN
NJ222752039OtherEIN