Provider Demographics
NPI:1720497670
Name:PISAREVSKY, YEVGENY (DDS)
Entity Type:Individual
Prefix:DR
First Name:YEVGENY
Middle Name:
Last Name:PISAREVSKY
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 1:907 SAINT MARKS AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-2004
Mailing Address - Country:US
Mailing Address - Phone:718-778-3283
Mailing Address - Fax:718-778-3284
Practice Address - Street 1:907 SAINT MARKS AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-2004
Practice Address - Country:US
Practice Address - Phone:718-778-3283
Practice Address - Fax:718-778-3284
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-05
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046086122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist