Provider Demographics
NPI:1891766853
Name:EISEN, NAOMI SHARON (MD)
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:SHARON
Last Name:EISEN
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 1:30 SHEPHERD LN
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-2507
Mailing Address - Country:US
Mailing Address - Phone:516-626-2950
Mailing Address - Fax:
Practice Address - Street 1:9745 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2106
Practice Address - Country:US
Practice Address - Phone:516-456-0356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202555-1207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G57113Medicare UPIN