Provider Demographics
NPI:1609008663
Name:EISMAN, PERRY STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:PERRY
Middle Name:STEVEN
Last Name:EISMAN
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 1:24 MILLFARM LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11968-2906
Mailing Address - Country:US
Mailing Address - Phone:631-259-2567
Mailing Address - Fax:
Practice Address - Street 1:24 MILLFARM LN
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-2906
Practice Address - Country:US
Practice Address - Phone:631-259-2567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-10
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY173075-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine