Provider Demographics
NPI:1952433849
Name:PISMAN, OLEG (DPM)
Entity type:Individual
Prefix:
First Name:OLEG
Middle Name:
Last Name:PISMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 152ND AVE NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-5521
Mailing Address - Country:US
Mailing Address - Phone:206-830-0920
Mailing Address - Fax:
Practice Address - Street 1:2001 152ND AVE NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-5521
Practice Address - Country:US
Practice Address - Phone:425-643-8901
Practice Address - Fax:425-643-8902
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006201213E00000X
WAPO 00000822213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10128382OtherCDPHP
NY4159492OtherMVP
NY000000121894OtherGHI HMO
NY0174899OtherGHI PPO
NY000413920001OtherBLUE SHIELD
NY02926130Medicaid
NY2850709OtherUNITEDHEALTHCARE
P00427572OtherRAILROAD MEDICARE
NY9692074OtherAETNA
NY4159492OtherMVP
NYP01210Medicare UPIN