Provider Demographics
NPI:1043445760
Name:EICHENBERGER, REGINA C K (PA-C, MPH, MS)
Entity type:Individual
Prefix:MS
First Name:REGINA
Middle Name:C K
Last Name:EICHENBERGER
Suffix:
Gender:F
Credentials:PA-C, MPH, MS
Other - Prefix:MS
Other - First Name:REGINA
Other - Middle Name:CELESTE
Other - Last Name:KISTNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C, MPH, MS
Mailing Address - Street 1:570 KING ST
Mailing Address - Street 2:
Mailing Address - City:CHAPPAQUA
Mailing Address - State:NY
Mailing Address - Zip Code:10514-3537
Mailing Address - Country:US
Mailing Address - Phone:914-238-1101
Mailing Address - Fax:
Practice Address - Street 1:2505 MAIN ST STE 223
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06615-5839
Practice Address - Country:US
Practice Address - Phone:203-375-5812
Practice Address - Fax:203-375-6027
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-26
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008159-1363A00000X
CT002266363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant