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Individual

TIMOTHY EISEMANN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
RN

Contact information

Practice address
52 THIRD AVE, BRENTWOOD, NY 11717
(631) 434-2401
Mailing address
52 THIRD AVE, BRENTWOOD, NY 11717

Taxonomy

Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
688996
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0
N/A
Enumeration date
11/19/2018
Last updated
11/19/2018
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