Andrew S Eisen

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

License

036958 Issued in NY

Practice address

168 Beach 121St St
Rockaway Park, NY 11694-1961

Phone

(917) 855-1305

NPI assigned

Feb 17, 2007

Last updated

Dec 26, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Andrew Eisen Physical Therapy, LLC

  • Physical Therapist
  • Seattle, WA
  • NPI 1912245192
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171670400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577318400000",
    "number": "1619011152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "168 BEACH 121ST ST",
            "city": "ROCKAWAY PARK",
            "state": "NY",
            "postal_code": "116941961",
            "telephone_number": "917-855-1305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "168 BEACH 121ST ST",
            "city": "ROCKAWAY PARK",
            "state": "NY",
            "postal_code": "116941961",
            "telephone_number": "917-855-1305"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "515 Minor Ave",
            "address_2": "SUITE 22",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981042120",
            "country_code": "US",
            "telephone_number": "206-386-5600",
            "fax_number": "206-386-5444",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EISEN",
        "first_name": "ANDREW",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-17",
        "last_updated": "2019-12-26",
        "certification_date": "2019-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "33468",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT60046366",
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "NY",
            "license": "036958",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "33468",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Orthopedic Physical Therapist in Rockaway Park, NY
• Providers in Rockaway Park, NY by specialty
• Orthopedic Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.