MEDICARE: MRS. LORI MICHELLE EISEN PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	0266711	NY

General Provider Information

NPI Number	:	1285717702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LORI MICHELLE EISEN PT

Provider Business Mailing Address
First Line	:	1560 BROADWAY
Second Line	:	STE 311
City	:	NY
State	:	NY
Zip	:	10036
Country	:	US
Telephone Number	:	212-354-2622
Fax Number	:	212-354-2752

Provider Business Practice Location Address
First Line	:	1560 BROADWAY
Second Line	:	STE 311
City	:	NEW YORK
State	:	NY
Zip	:	10036
Country	:	US
Telephone Number	:	212-354-2622
Fax Number	:	212-354-2752

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2006
Last Update Date	:	07/08/2007

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