Provider Demographics
NPI:1356386353
Name:ZEIDMAN, ANDREW E (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:E
Last Name:ZEIDMAN
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 1:140 W 58TH ST
Mailing Address - Street 2:STE A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-2182
Mailing Address - Country:US
Mailing Address - Phone:212-765-5030
Mailing Address - Fax:212-765-5041
Practice Address - Street 1:140 W 58TH ST
Practice Address - Street 2:STE A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-2182
Practice Address - Country:US
Practice Address - Phone:212-765-5030
Practice Address - Fax:212-765-5041
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY03984211223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
D0G911Medicare ID - Type Unspecified
T49300Medicare UPIN