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General NPI Number Information
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NPI Number | 1760736722
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Entity Type | Individual
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Provider Name | EITAN PRISMAN MD
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Gender | Male
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Dates
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Enumeration Date | 10/30/2012
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Last Update Date | 10/30/2012
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Provider Practice Location Address
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Address Line | ONE GUSTAVE LEVY PLACE ANNENBERG 10-50
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City | NEW YORK
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State | NY
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Zip | 10029-6574
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Country | US
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Telephone | 212-241-9144
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Fax |
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Provider Business Mailing Address
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Address Line | 128 E 83RD ST APARTMENT 1B
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City | NEW YORK
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State | NY
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Zip | 10028-0812
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Country | US
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Telephone | 917-566-7607
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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 | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 004112-1
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License Number State | NY
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