Provider Demographics
NPI:1730427246
Name:EISNER, JODI L (OTR/L)
Entity type:Individual
Prefix:MS
First Name:JODI
Middle Name:L
Last Name:EISNER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 LINCOLN DR W
Mailing Address - Street 2:SUITE I
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-1528
Mailing Address - Country:US
Mailing Address - Phone:856-396-3173
Mailing Address - Fax:
Practice Address - Street 1:3001 LINCOLN DR W
Practice Address - Street 2:SUITE I
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-1528
Practice Address - Country:US
Practice Address - Phone:856-396-3173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00603600174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ131138OtherMEDICARE PTAN