Basic Information
| Provider Information | |||||||||
| NPI: | 1841351947 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EISEN | ||||||||
| FirstName: | SETH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 510 HICKSVILLE RD | ||||||||
| Address2: | |||||||||
| City: | MASSAPEQUA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117581203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5167952626 | ||||||||
| FaxNumber: | 5167997451 | ||||||||
| Practice Location | |||||||||
| Address1: | 510 HICKSVILLE RD | ||||||||
| Address2: | |||||||||
| City: | MASSAPEQUA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117581203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5167952626 | ||||||||
| FaxNumber: | 5167997451 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2006 | ||||||||
| LastUpdateDate: | 08/26/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 143891 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 201285536 | 01 | MAGNACARE | OTHER | 201285536 | 01 | UHC | OTHER | 2590537 | 01 | GHI | OTHER | 34051 | 01 | VYTRA | OTHER | P00187616 | 01 | RR MCR | OTHER | 201285536 | 01 | PHCS | OTHER | 2C7636 | 01 | PHS | OTHER | 12774P | 01 | HIP | OTHER | 259AC1 | 01 | BLUE CROSS BLUE SHIELD | OTHER | AA45492A | 01 | MDNY | OTHER | 00797782 | 05 | NY | MEDICAID | 201285536 | 01 | EMPIRE | OTHER | 3C7538 | 01 | HEALTHNET | OTHER | 5342932 | 01 | CIGNA | OTHER | 201285536 | 01 | HORIZON | OTHER | P471137 | 01 | OXFORD | OTHER |