Provider Demographics
NPI:1407112378
Name:EISNER, STEVEN J (DO)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:J
Last Name:EISNER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 SEAFORTH LN
Mailing Address - Street 2:
Mailing Address - City:LLOYD HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11743-9714
Mailing Address - Country:US
Mailing Address - Phone:631-385-8590
Mailing Address - Fax:
Practice Address - Street 1:14 SEAFORTH LN
Practice Address - Street 2:
Practice Address - City:LLOYD HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11743-9714
Practice Address - Country:US
Practice Address - Phone:631-385-8590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60-136839207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY60-136839OtherNYS LICENSE #