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General NPI Number Information
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NPI Number | 1003585142
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Entity Type | Individual
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Provider Name | JAMIE EISEMAN PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 09/11/2021
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Last Update Date | 09/11/2021
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Provider Practice Location Address
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Address Line | 1025 NORTHERN BLVD STE 95
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City | ROSLYN
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State | NY
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Zip | 11576-1506
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Country | US
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Telephone | 917-817-4004
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Fax |
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Provider Business Mailing Address
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Address Line | 21 BARSTOW RD APT 2I
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City | GREAT NECK
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State | NY
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Zip | 11021-2205
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Country | US
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Telephone | 516-578-4245
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 024081
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License Number State | NY
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