Healthcare Provider Details

I. General information

NPI: 1497922280
Provider Name (Legal Business Name): LAURA EISMONT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA DAUGIALAITE

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 05/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 GRAND CONCOURSE
BRONX NY
10457-7606
US

IV. Provider business mailing address

16914 21ST AVE
WHITESTONE NY
11357-4102
US

V. Phone/Fax

Practice location:
  • Phone: 718-579-2647
  • Fax:
Mailing address:
  • Phone: 347-866-2999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number260878
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: