Provider Demographics
NPI:1457676900
Name:EISENSTEIN-ROSAN, POLA FAY (PH D)
Entity type:Individual
Prefix:DR
First Name:POLA
Middle Name:FAY
Last Name:EISENSTEIN-ROSAN
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2517 ROUTE 44 STE 11-194
Mailing Address - Street 2:
Mailing Address - City:SALT POINT
Mailing Address - State:NY
Mailing Address - Zip Code:12578-8016
Mailing Address - Country:US
Mailing Address - Phone:646-841-3429
Mailing Address - Fax:
Practice Address - Street 1:2461 ROUTE 44 STE 11-194
Practice Address - Street 2:
Practice Address - City:SALT POINT
Practice Address - State:NY
Practice Address - Zip Code:12578-8005
Practice Address - Country:US
Practice Address - Phone:646-463-3948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-27
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014916-1103TF0200X, 103TC0700X, 103G00000X
NY1741676103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent