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General NPI Number Information
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NPI Number | 1750872677
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Entity Type | Individual
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Provider Name | JEFFREY WEISBORD DDS
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Gender | Male
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Dates
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Enumeration Date | 05/25/2018
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Last Update Date | 09/12/2020
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Provider Practice Location Address
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Address Line | 10420 QUEENS BLVD STE 1G
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City | FOREST HILLS
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State | NY
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Zip | 11375-8149
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Country | US
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Telephone | 347-566-1392
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Fax |
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Provider Business Mailing Address
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Address Line | 20 CONTINENTAL AVE APT 4G
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City | FOREST HILLS
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State | NY
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Zip | 11375-5224
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Country | US
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Telephone |
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 060610
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License Number State | NY
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