Provider Demographics
NPI:1871777813
Name:JACK EISENSTEIN,D.P.M.
Entity type:Organization
Organization Name:JACK EISENSTEIN,D.P.M.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:EISENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-353-4307
Mailing Address - Street 1:18-15 COLLEGE PONT BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:COLLEGE POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11356
Mailing Address - Country:US
Mailing Address - Phone:718-353-4307
Mailing Address - Fax:718-539-7558
Practice Address - Street 1:18-15 COLLEGE POINT BOULEVARD
Practice Address - Street 2:
Practice Address - City:COLLEGE POINT
Practice Address - State:NY
Practice Address - Zip Code:11356
Practice Address - Country:US
Practice Address - Phone:718-353-4307
Practice Address - Fax:718-539-7558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNO2938332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1871777813Medicare UPIN
NY4585130001Medicare NSC