MEDICARE: EUGENE KENIGSBERG D.D.S., P.C.

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	122300000X	Dentist	054004	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770850810
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EUGENE KENIGSBERG D.D.S., P.C.

Provider Business Mailing Address
First Line	:	1804 FLATBUSH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-4302
Country	:	US
Telephone Number	:	718-253-2000
Fax Number	:	718-253-2089

Provider Business Practice Location Address
First Line	:	1804 FLATBUSH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-4302
Country	:	US
Telephone Number	:	718-253-2000
Fax Number	:	718-253-2089

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. EUGENE KENIGSBERG
Credential	:	D.D.S.
Telephone Number	:	917-270-9244

Provider Enumeration Date	:	11/17/2011
Last Update Date	:	11/17/2011

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