1134172364 NPI number — DR. EUGENE HERBERT EISMAN MD

Table of content: DR. EUGENE HERBERT EISMAN MD (NPI 1134172364)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134172364 NPI number — DR. EUGENE HERBERT EISMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EISMAN
Provider First Name:
EUGENE
Provider Middle Name:
HERBERT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134172364
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17971 BISCAYNE BLVD
Provider Second Line Business Mailing Address:
SUITE 208
Provider Business Mailing Address City Name:
AVENTURA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33160-2578
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-932-7814
Provider Business Mailing Address Fax Number:
305-466-9051

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17971 BISCAYNE BLVD
Provider Second Line Business Practice Location Address:
SUITE 208
Provider Business Practice Location Address City Name:
AVENTURA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33160-2578
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-932-7814
Provider Business Practice Location Address Fax Number:
305-466-9051
Provider Enumeration Date:
05/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  ME0015832 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 677145 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1691326 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 0004109955 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 24615 . This is a "NEIGHBORHOOD HEALTH PARTNERSHIP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 91494 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 060068682 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 007806400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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