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General NPI Number Information
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NPI Number | 1710044904
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Entity Type | Individual
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Provider Name | SIDNEY BERNARD EISIG DDS
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Gender | Male
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 630 W 168TH ST SUITE VC7-226
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City | NEW YORK
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State | NY
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Zip | 10032-3725
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Country | US
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Telephone | 212-305-4552
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Fax | 212-305-9649
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Provider Business Mailing Address
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Address Line | 180 FORT WASHINGTON AVE SUITE HP8-802
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City | NEW YORK
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State | NY
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Zip | 10032-3735
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Country | US
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Telephone | 212-305-8516
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Fax | 212-305-9017
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 036028
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License Number State | NY
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