Provider Demographics
NPI:1164534202
Name:BRISSON, PAUL-MARIE JEROME (MD)
Entity Type:Individual
Prefix:
First Name:PAUL-MARIE
Middle Name:JEROME
Last Name:BRISSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 - E 25TH STREET
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:NEW YORK CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10010
Mailing Address - Country:US
Mailing Address - Phone:212-813-3632
Mailing Address - Fax:212-696-0108
Practice Address - Street 1:51 - E 25TH STREET
Practice Address - Street 2:6TH FLOOR
Practice Address - City:NEW YORK CITY
Practice Address - State:NY
Practice Address - Zip Code:10010
Practice Address - Country:US
Practice Address - Phone:212-813-3632
Practice Address - Fax:212-696-0108
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY188579207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF-19918Medicare UPIN
NY26K621Medicare ID - Type Unspecified