Provider Demographics
NPI:1245231687
Name:PISMAN, ANATOLY (MD)
Entity Type:Individual
Prefix:
First Name:ANATOLY
Middle Name:
Last Name:PISMAN
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 1:1919 E 27TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-2536
Mailing Address - Country:US
Mailing Address - Phone:718-339-3079
Mailing Address - Fax:
Practice Address - Street 1:1911 AVENUE L
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-5002
Practice Address - Country:US
Practice Address - Phone:718-859-3499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210766204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01911760Medicaid
NY01911760Medicaid
NY45N422Medicare ID - Type Unspecified