Provider Demographics
NPI:1417940024
Name:NEWMAN, JACK IRA (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:IRA
Last Name:NEWMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 BAYBERRY LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-4800
Mailing Address - Country:US
Mailing Address - Phone:914-234-7468
Mailing Address - Fax:
Practice Address - Street 1:150 GREENWAY TER
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-5267
Practice Address - Country:US
Practice Address - Phone:718-793-5577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023685-11223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics