Basic Information
| Provider Information | |||||||||
| NPI: | 1710274949 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EISENBERG | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | SHAMOIL | ||||||||
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| Credential: | AU.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7431 W ATLANTIC AVE | ||||||||
| Address2: | SUITE 43 | ||||||||
| City: | DELRAY BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334463512 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 7431 W ATLANTIC AVE | ||||||||
| Address2: | SUITE 43 | ||||||||
| City: | DELRAY BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334463512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614962082 | ||||||||
| FaxNumber: | 5614964448 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2011 | ||||||||
| LastUpdateDate: | 01/13/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237600000X | 002348 | NY | N | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter | 231H00000X | AY1895 | FL | Y | Speech, Language and Hearing Service Providers | Audiologist |
ID Information
| ID | Type | State | Issuer | Description | 14000031226 | 01 | NYS HEARING AID DISPENSING LICENSE | OTHER |