Provider Demographics
NPI:1417116013
Name:JEFFREY D HAIMSON DMD PLLC
Entity Type:Organization
Organization Name:JEFFREY D HAIMSON DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:D
Authorized Official - Last Name:HAIMSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:718-429-0440
Mailing Address - Street 1:83 06 NORTHERN BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:07054-1460
Mailing Address - Country:US
Mailing Address - Phone:718-429-0440
Mailing Address - Fax:718-429-0342
Practice Address - Street 1:8306 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-1460
Practice Address - Country:US
Practice Address - Phone:718-429-0440
Practice Address - Fax:718-429-0342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0428961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01221392Medicaid