Jacob Eisdorfer, D.D.S.

Primary specialty

Dental AnesthesiologyTaxonomy code 1223D0004X

License

00055621 Issued in NY

Practice address

1162 42ND St
Brooklyn, NY 11219-1213

Phone

(347) 209-7158

NPI assigned

Apr 4, 2010

Last updated

Mar 24, 2015By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Networks

• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H3359

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1270339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1427155200000",
    "number": "1881919728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1162 42ND ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112191213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1162 42ND ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112191213",
            "telephone_number": "347-209-7158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EISDORFER",
        "first_name": "JACOB",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-04-04",
        "last_updated": "2015-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223D0004X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Anesthesiology",
            "state": "NY",
            "license": "00055621",
            "primary": true
        },
        {
            "code": "1223D0004X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Anesthesiology",
            "state": "NJ",
            "license": "22DI02480400",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "00055621",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NJ",
            "license": "22DI02480400",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03355406",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Daniel Eiras, M.D.
• Avital Penina Eis, M.S.
• Ayala Eis, LMSW
• Yecheskel Eis
• Jacob Eisdorfer, DO
• Miriam Eisdorfer, PSY.D.
• Sara Eisdorfer
• Caroline Eiseman, LCSW
• Sam Eisen
• Vicki Ellen Eisen, LMSW

• Dental Anesthesiology in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Dental Anesthesiology in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.