Provider Demographics
NPI:1700814159
Name:EISENSTEIN, JACK (DPM)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:
Last Name:EISENSTEIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 EAGLE CHASE
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-2911
Mailing Address - Country:US
Mailing Address - Phone:516-816-9619
Mailing Address - Fax:718-539-7558
Practice Address - Street 1:18-15 COLLEGE POINT BLVD.
Practice Address - Street 2:
Practice Address - City:COLLEGE POINT
Practice Address - State:NY
Practice Address - Zip Code:11356
Practice Address - Country:US
Practice Address - Phone:718-353-4307
Practice Address - Fax:718-538-7558
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN002938213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT31761Medicare UPIN