Provider Demographics
NPI:1447249933
Name:KESTENBAUM, JOEL N (OD)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:N
Last Name:KESTENBAUM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:431 S OYSTER BAY RD
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-3313
Mailing Address - Country:US
Mailing Address - Phone:516-931-6330
Mailing Address - Fax:516-931-6352
Practice Address - Street 1:431 S OYSTER BAY RD
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-3313
Practice Address - Country:US
Practice Address - Phone:516-931-6330
Practice Address - Fax:516-931-6352
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT003883152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU18022Medicare UPIN
NYC81421Medicare PIN