Healthcare Provider Details

I. General information

NPI: 1982613907
Provider Name (Legal Business Name): RICHARD STUART EISNER D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 HIGHLAND AVE SUITE #103
SALEM MA
01970-2185
US

IV. Provider business mailing address

55 HIGHLAND AVE SUITE #103
SALEM MA
01970-2185
US

V. Phone/Fax

Practice location:
  • Phone: 978-744-5991
  • Fax: 978-745-6780
Mailing address:
  • Phone: 978-744-5991
  • Fax: 978-745-6780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number1666
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: