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General NPI Number Information
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NPI Number | 1558569194
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Entity Type | Organization
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Legal Business Name | HECTOR FALLS INTEGRATIVE MEDICINE
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Dates
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Enumeration Date | 07/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3835 STATE ROUTE 414
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City | BURDETT
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State | NY
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Zip | 14818-9744
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Country | US
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Telephone | 607-546-7193
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Fax | 607-546-4091
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Provider Business Mailing Address
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Address Line | 3835 STATE ROUTE 414
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City | BURDETT
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State | NY
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Zip | 14818-9744
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Country | US
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Telephone | 607-546-7193
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Fax | 607-546-4091
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Authorized Official
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Title or Position | M.D.
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Name | DR. MICHAEL EISMAN
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Credential | M.D.
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Telephone | 607-546-7193
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 131704-1
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License Number State | NY
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