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General NPI Number Information
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NPI Number | 1245231687
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Entity Type | Individual
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Provider Name | ANATOLY PISMAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/09/2005
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Last Update Date | 02/11/2014
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Provider Practice Location Address
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Address Line | 1911 AVENUE L
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City | BROOKLYN
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State | NY
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Zip | 11230-5002
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Country | US
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Telephone | 718-859-3499
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Fax |
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Provider Business Mailing Address
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Address Line | 1919 E 27TH ST
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City | BROOKLYN
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State | NY
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Zip | 11229-2536
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Country | US
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Telephone | 718-339-3079
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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 | 204C00000X
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Taxonomy Name | Sports Medicine (Neuromusculoskeletal Medicine) Physician
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License Number | 210766
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License Number State | NY
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