Provider Demographics
NPI:1144474602
Name:EISSENBERG, MIRIAM ESTER (MS-CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:ESTER
Last Name:EISSENBERG
Suffix:
Gender:F
Credentials:MS-CCC/SLP
Other - Prefix:MISS
Other - First Name:MIRIAM
Other - Middle Name:ESTER
Other - Last Name:STEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 VAN WINKLE RD
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-1330
Mailing Address - Country:US
Mailing Address - Phone:845-364-9595
Mailing Address - Fax:845-364-9595
Practice Address - Street 1:2 VAN WINKLE RD
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-1330
Practice Address - Country:US
Practice Address - Phone:845-364-9595
Practice Address - Fax:845-364-9595
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014601-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist