Individual
JACOB EISDORFER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1162 42ND ST, BROOKLYN, NY 11219-1213
(347) 209-7158
Mailing address
1162 42ND ST, BROOKLYN, NY 11219-1213
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
00055621
NY
122300000X
Dentist
22DI02480400
NJ
1223D0004X
Dental Anesthesiology
Primary
00055621
NY
1223D0004X
Dental Anesthesiology
22DI02480400
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03355406
—
NY
Enumeration date
04/04/2010
Last updated
03/24/2015
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