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General NPI Number Information
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NPI Number | 1336618941
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Entity Type | Organization
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Legal Business Name | STACEY F BRISMAN MD PC
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Dates
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Enumeration Date | 11/13/2018
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Last Update Date | 02/09/2023
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Provider Practice Location Address
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Address Line | 50 GLEN COVE RD
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City | GREENVALE
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State | NY
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Zip | 11548-1062
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Country | US
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Telephone | 516-621-1982
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Fax | 516-621-1340
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Provider Business Mailing Address
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Address Line | PO BOX 1153
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City | SYOSSET
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State | NY
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Zip | 11791-0489
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Country | US
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Telephone | 516-621-1982
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Fax | 516-621-1340
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | STACEY F BRISMAN
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Credential | MD
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Telephone | 516-200-3545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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