Provider Demographics
NPI:1558161661
Name:ISHMAN, ERIC (CASAC)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:ISHMAN
Suffix:
Gender:
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 CHAUNCEY LN
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-3504
Mailing Address - Country:US
Mailing Address - Phone:347-804-4199
Mailing Address - Fax:
Practice Address - Street 1:23 CHAUNCEY LN
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-3504
Practice Address - Country:US
Practice Address - Phone:347-804-4199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18293101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)