MEDICARE: NAOMI SHARON EISEN MD

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	207L00000X	Anesthesiology Physician	202555-1	NY

General Provider Information

NPI Number	:	1891766853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAOMI SHARON EISEN MD

Provider Business Mailing Address
First Line	:	30 SHEPHERD LN
Second Line	:
City	:	ROSLYN HEIGHTS
State	:	NY
Zip	:	11577-2507
Country	:	US
Telephone Number	:	516-626-2950
Fax Number	:

Provider Business Practice Location Address
First Line	:	9745 QUEENS BLVD
Second Line	:
City	:	REGO PARK
State	:	NY
Zip	:	11374-2106
Country	:	US
Telephone Number	:	516-456-0356
Fax Number	:

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

Provider Enumeration Date	:	01/29/2006
Last Update Date	:	07/08/2007

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