Healthcare Provider Details

I. General information

NPI: 1962198804
Provider Name (Legal Business Name): JAMIE SILVERBERG DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 PARK AVE APT 1G
NEW YORK NY
10065-8058
US

IV. Provider business mailing address

2201 CHESTNUT ST APT 103
PHILADELPHIA PA
19103-3009
US

V. Phone/Fax

Practice location:
  • Phone: 212-758-0040
  • Fax:
Mailing address:
  • Phone: 856-906-6105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS043890
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: