Provider Demographics
NPI:1679581995
Name:JOSEPHSON, ERIC JEFFREY (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:JEFFREY
Last Name:JOSEPHSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 WEST 57TH ST
Mailing Address - Street 2:SUITE #1214
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019
Mailing Address - Country:US
Mailing Address - Phone:212-713-0588
Mailing Address - Fax:212-713-0035
Practice Address - Street 1:119 WEST 57TH ST
Practice Address - Street 2:SUITE #1214
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019
Practice Address - Country:US
Practice Address - Phone:212-713-0588
Practice Address - Fax:212-713-0035
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037323122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00884588Medicaid