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General NPI Number Information
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NPI Number | 1366768319
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Entity Type | Organization
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Legal Business Name | EISNY OT/PT/SLP PLLC
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Dates
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Enumeration Date | 04/15/2010
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Last Update Date | 04/15/2010
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Provider Practice Location Address
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Address Line | 189 ROUTE 100
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City | SOMERS
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State | NY
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Zip | 10589-2811
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Country | US
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Telephone | 914-373-6520
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Fax | 914-373-6521
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Provider Business Mailing Address
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Address Line | PO BOX 441
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City | SOMERS
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State | NY
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Zip | 10589-0441
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Country | US
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Telephone | 914-373-6520
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Fax | 914-373-6521
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MANJUSHA MEHRA
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Credential | OTR
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Telephone | 914-373-6520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 25296
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License Number State | NY
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