1518099209 NPI number — DIAMOND DISTRICT CORNEAL, P.C.

Table of content: (NPI 1518099209)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518099209 NPI number — DIAMOND DISTRICT CORNEAL, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIAMOND DISTRICT CORNEAL, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COHEN EYE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518099209
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
56-50 MYRTLE AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIDGEWOOD
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11385
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-456-9500
Provider Business Mailing Address Fax Number:
718-497-8762

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
56-50 MYRTLE AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIDGEWOOD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11385
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-456-9500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/09/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
COHEN
Authorized Official First Name:
ILAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
718-456-9500

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: G400008555 . This is a "MEDICARE INDIVIDUAL PTAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P00818737 . This is a "RAILROAD MEDICARE INDIVIDUAL PTAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: DQ1530 . This is a "RAILROAD MEDICARE GROUP PTAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02426864 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".