Provider Demographics
NPI:1558569194
Name:HECTOR FALLS INTEGRATIVE MEDICINE
Entity Type:Organization
Organization Name:HECTOR FALLS INTEGRATIVE MEDICINE
Other - Org Name:MICHAEL EISMAN, MD
Other - Org Type:Other Name
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:EISMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-546-7193
Mailing Address - Street 1:3835 STATE ROUTE 414
Mailing Address - Street 2:
Mailing Address - City:BURDETT
Mailing Address - State:NY
Mailing Address - Zip Code:14818-9744
Mailing Address - Country:US
Mailing Address - Phone:607-546-7193
Mailing Address - Fax:607-546-4091
Practice Address - Street 1:3835 STATE ROUTE 414
Practice Address - Street 2:
Practice Address - City:BURDETT
Practice Address - State:NY
Practice Address - Zip Code:14818-9744
Practice Address - Country:US
Practice Address - Phone:607-546-7193
Practice Address - Fax:607-546-4091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY131704-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00395666Medicaid
NYB81871Medicare UPIN
NYAA1689Medicare ID - Type UnspecifiedMEDICARE GROUP