Healthcare Provider Details

I. General information

NPI: 1316197429
Provider Name (Legal Business Name): ERIC BRIAN SNITOFSKY D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2008
Last Update Date: 09/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221-10 JAMAICA AVENUE SUITE 103
QUEENS VILLAGE NY
11428
US

IV. Provider business mailing address

221-10 JAMAICA AVENUE SUITE 103
QUEENS VILLAGE NY
11428
US

V. Phone/Fax

Practice location:
  • Phone: 718-464-9216
  • Fax: 718-464-9216
Mailing address:
  • Phone: 718-464-9216
  • Fax: 718-464-9216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number043437
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: