Individual
DR. CHARLES B EISENSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1814 5TH AVE, BAY SHORE, NY 11706-1732
(631) 273-8111
Mailing address
1814 5TH AVE, BAY SHORE, NY 11706-1732
(631) 273-8111
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
50-035147
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00667450
—
NY
Enumeration date
11/07/2006
Last updated
07/08/2007
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