Healthcare Provider Details

I. General information

NPI: 1003657628
Provider Name (Legal Business Name): ESTHER SHERBAK OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2024
Last Update Date: 01/27/2026
Certification Date: 01/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 E FORDHAM RD FL 1
BRONX NY
10458-5049
US

IV. Provider business mailing address

625 E FORDHAM RD FL 1
BRONX NY
10458-5049
US

V. Phone/Fax

Practice location:
  • Phone: 718-475-6912
  • Fax: 718-313-4515
Mailing address:
  • Phone: 718-475-6912
  • Fax: 718-313-4515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number35725
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: