Healthcare Provider Details

I. General information

NPI: 1043445760
Provider Name (Legal Business Name): REGINA C K EICHENBERGER PA-C, MPH, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: REGINA CELESTE KISTNER PA-C, MPH, MS

II. Dates (important events)

Enumeration Date: 05/26/2009
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WOODS RD
VALHALLA NY
10595-1530
US

IV. Provider business mailing address

400 COLUMBUS AVE STE 200E
VALHALLA NY
10595-1392
US

V. Phone/Fax

Practice location:
  • Phone: 914-614-4343
  • Fax:
Mailing address:
  • Phone: 914-614-4343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number008159-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number002266
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: