Provider Demographics
NPI:1679720825
Name:BRISMAN, STACEY F (MD)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:F
Last Name:BRISMAN
Suffix:
Gender:F
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:PO BOX 1153
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-0489
Mailing Address - Country:US
Mailing Address - Phone:516-621-1982
Mailing Address - Fax:516-621-1340
Practice Address - Street 1:50 GLEN COVE RD
Practice Address - Street 2:
Practice Address - City:GREENVALE
Practice Address - State:NY
Practice Address - Zip Code:11548-1062
Practice Address - Country:US
Practice Address - Phone:516-200-3545
Practice Address - Fax:516-876-8010
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2395481207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology