Provider Demographics
NPI:1710044904
Name:EISIG, SIDNEY BERNARD (DDS)
Entity Type:Individual
Prefix:
First Name:SIDNEY
Middle Name:BERNARD
Last Name:EISIG
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 1:180 FORT WASHINGTON AVE
Mailing Address - Street 2:SUITE HP8-802
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3735
Mailing Address - Country:US
Mailing Address - Phone:212-305-8516
Mailing Address - Fax:212-305-9017
Practice Address - Street 1:630 W 168TH ST
Practice Address - Street 2:SUITE VC7-226
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3725
Practice Address - Country:US
Practice Address - Phone:212-305-4552
Practice Address - Fax:212-305-9649
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0360281223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4309559OtherAETNA PPO
NY45913POtherHIP MEDICAID
NY036028N02OtherHIP
NYD48781OtherEMPIRE BCBS
NYGS361OtherOXFORD
NY683721OtherUNITED HEALTHCARE
NY0348187OtherCIGNA
NY2635591OtherAETNA HMO
NY1300099OtherGHI
NY4C1608OtherHEALTHNET PHS
NY00964356Medicaid
NY4C1608OtherHEALTHNET PHS