1235150996 NPI number — EISMAN & EISMAN MD PA

Table of content: (NPI 1235150996)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235150996 NPI number — EISMAN & EISMAN MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EISMAN & EISMAN MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1235150996
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17971 BISCAYNE BLVD STE 208
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AVENTURA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33160-2532
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 STE 208
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AVENTURA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33160
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:
07/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
EISMAN
Authorized Official First Name:
EUGENE
Authorized Official Middle Name:
HERBERT
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
305-932-7814

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  ME0015831 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • 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: CK3012 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 129800414874 . This is a "HUMANA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1492299 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 00159 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 677143 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 0007698322 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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