Healthcare Provider Details

I. General information

NPI: 1548181142
Provider Name (Legal Business Name): AVIGDOR KIRSCHENBAUM RDH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HANSON PL APT 13D
BROOKLYN NY
11243-2919
US

IV. Provider business mailing address

1 HANSON PL APT 13D
BROOKLYN NY
11243-2919
US

V. Phone/Fax

Practice location:
  • Phone: 917-474-1941
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number031102
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: