Provider Demographics
NPI:1972543320
Name:EISMAN, JO (DC)
Entity Type:Individual
Prefix:DR
First Name:JO
Middle Name:
Last Name:EISMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-2605
Mailing Address - Country:US
Mailing Address - Phone:516-431-7972
Mailing Address - Fax:516-431-7944
Practice Address - Street 1:714 E PARK AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-2605
Practice Address - Country:US
Practice Address - Phone:516-431-7972
Practice Address - Fax:516-431-7944
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3172111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY320923OtherAETNA
NY1972543320OtherMEDICARE ID
NY320923OtherAETNA