Provider Demographics
NPI:1841351947
Name:EISEN, SETH (MD)
Entity type:Individual
Prefix:DR
First Name:SETH
Middle Name:
Last Name:EISEN
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 1:510 HICKSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-1203
Mailing Address - Country:US
Mailing Address - Phone:516-795-2626
Mailing Address - Fax:516-799-7451
Practice Address - Street 1:510 HICKSVILLE RD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-1203
Practice Address - Country:US
Practice Address - Phone:516-795-2626
Practice Address - Fax:516-799-7451
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY143891207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
201285536OtherMAGNACARE
201285536OtherUHC
2590537OtherGHI
34051OtherVYTRA
P00187616OtherRR MCR
201285536OtherPHCS
2C7636OtherPHS
12774POtherHIP
259AC1OtherBLUE CROSS BLUE SHIELD
AA45492AOtherMDNY
NY00797782Medicaid
201285536OtherEMPIRE
3C7538OtherHEALTHNET
5342932OtherCIGNA
201285536OtherHORIZON
P471137OtherOXFORD
2590537OtherGHI
259AC1OtherBLUE CROSS BLUE SHIELD