Provider Demographics
NPI:1487745121
Name:EISEN, DEBORAH A (MD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:A
Last Name:EISEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 HENRY HUDSON PKWY
Mailing Address - Street 2:SUITE 1E
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1521
Mailing Address - Country:US
Mailing Address - Phone:718-601-1540
Mailing Address - Fax:
Practice Address - Street 1:7619 168TH ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11366-1333
Practice Address - Country:US
Practice Address - Phone:718-380-4302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241911-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine