MEDICARE: DR. JACOB EISDORFER DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208C00000X	Colon & Rectal Surgery Physician	25MB09093600	NJ
2	208C00000X	Colon & Rectal Surgery Physician	270778	NY

General Provider Information

NPI Number	:	1487706255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACOB EISDORFER DO

Provider Business Mailing Address
First Line	:	1 BROOKDALE PLAZA
Second Line	:	PHYSICIAN ENTERPRISE SERVICES
City	:	BROOKLYN
State	:	NY
Zip	:	11212
Country	:	US
Telephone Number	:	718-240-7904
Fax Number	:	718-240-7393

Provider Business Practice Location Address
First Line	:	1235 LINDEN BLVD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11212-2438
Country	:	US
Telephone Number	:	718-240-7904
Fax Number	:	718-240-7393

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	07/19/2024

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