MEDICARE: DR. BERNARD M EISEN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	0339421	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437140191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BERNARD M EISEN DDS

Provider Business Mailing Address
First Line	:	21 CENTER STREET
Second Line	:
City	:	ANGOLA
State	:	NY
Zip	:	14006
Country	:	US
Telephone Number	:	716-549-3111
Fax Number	:	716-549-5667

Provider Business Practice Location Address
First Line	:	21 CENTER STREET
Second Line	:
City	:	ANGOLA
State	:	NY
Zip	:	14006
Country	:	US
Telephone Number	:	716-549-3111
Fax Number	:	716-549-5667

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	07/08/2007

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