Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213EP1101X | Primary Podiatric Medicine | SC006113 | PA |
Y | 213ES0103X | Foot & Ankle Surgery | SC006113 | PA |
NPI | 1417283409 |
---|---|
Provider Name | Dr. Aliza Vazana Eisen |
First Address | Ardmore, PA 19003-2209 |
Second Address | Ardmore, PA 19003-2209 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2009 |
Last Update Date | 17/02/2020 |