Provider Demographics
NPI:1336618941
Name:STACEY F BRISMAN MD PC
Entity Type:Organization
Organization Name:STACEY F BRISMAN MD PC
Other - Org Name:WALK-IN DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:F
Authorized Official - Last Name:BRISMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-200-3545
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:516-621-1982
Practice Address - Fax:516-621-1340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-13
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty