Provider Demographics
NPI:1760736722
Name:PRISMAN, EITAN (MD)
Entity Type:Individual
Prefix:
First Name:EITAN
Middle Name:
Last Name:PRISMAN
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 1:128 E 83RD ST
Mailing Address - Street 2:APARTMENT 1B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0812
Mailing Address - Country:US
Mailing Address - Phone:917-566-7607
Mailing Address - Fax:
Practice Address - Street 1:ONE GUSTAVE LEVY PLACE
Practice Address - Street 2:ANNENBERG 10-50
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6574
Practice Address - Country:US
Practice Address - Phone:212-241-9144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004112-1207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology