Provider Demographics
NPI:1326017617
Name:EISLER, JESSE (MD)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:EISLER
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 1:460 HARTFORD TPKE
Mailing Address - Street 2:SUITE B
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-4845
Mailing Address - Country:US
Mailing Address - Phone:860-872-6229
Mailing Address - Fax:860-872-6252
Practice Address - Street 1:460 HARTFORD TPKE
Practice Address - Street 2:SUITE B
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-4845
Practice Address - Country:US
Practice Address - Phone:860-872-6229
Practice Address - Fax:860-872-6252
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT043032207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT061746779OtherTAX ID
CTC03399Medicare PIN