Healthcare Provider Details

I. General information

NPI: 1710200605
Provider Name (Legal Business Name): JILL M KRAMER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2010
Last Update Date: 03/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270-05 76TH AVE
NEW HYDE PARK NY
11040-1402
US

IV. Provider business mailing address

7339 255TH ST
GLEN OAKS NY
11004-1133
US

V. Phone/Fax

Practice location:
  • Phone: 718-470-4103
  • Fax: 516-470-5644
Mailing address:
  • Phone: 716-984-2027
  • Fax: 516-470-5644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number052951
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: