Healthcare Provider Details

I. General information

NPI: 1376480244
Provider Name (Legal Business Name): DANIEL EIDMAN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

248 KNICKERBOCKER RD
DUMONT NJ
07628-1708
US

IV. Provider business mailing address

248 KNICKERBOCKER RD
DUMONT NJ
07628-1708
US

V. Phone/Fax

Practice location:
  • Phone: 201-385-2849
  • Fax:
Mailing address:
  • Phone: 201-385-2849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL EIDMAN
Title or Position: DENTIST,OWNER
Credential: DDS
Phone: 917-239-2245