Provider Demographics
NPI:1770023806
Name:AIZENSTEIN, JACK (CO)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:
Last Name:AIZENSTEIN
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 E 55TH ST
Mailing Address - Street 2:207
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4038
Mailing Address - Country:US
Mailing Address - Phone:212-888-7372
Mailing Address - Fax:212-888-1551
Practice Address - Street 1:155 E 55TH ST
Practice Address - Street 2:207
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4038
Practice Address - Country:US
Practice Address - Phone:212-888-7372
Practice Address - Fax:212-888-1551
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier