Provider Demographics
NPI:1053571463
Name:ROSENFELD, ELISHEVA AZIZA (DDS)
Entity type:Individual
Prefix:
First Name:ELISHEVA
Middle Name:AZIZA
Last Name:ROSENFELD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ELISHEVA
Other - Middle Name:
Other - Last Name:JACOB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1325 FRANKLIN AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-1631
Mailing Address - Country:US
Mailing Address - Phone:516-879-7609
Mailing Address - Fax:516-879-7610
Practice Address - Street 1:1325 FRANKLIN AVE STE 101
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-1631
Practice Address - Country:US
Practice Address - Phone:516-879-7609
Practice Address - Fax:516-879-7610
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0574401223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery