1386794980 NPI number — NEW VISION CATARACT CENTER LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386794980 NPI number — NEW VISION CATARACT CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW VISION CATARACT CENTER LLC
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:
Provider Other Organization Name Type Code:
6
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:
1386794980
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
825 E GATE BLVD STE 111
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARDEN CITY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11530-2136
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-804-5200
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
605 WEST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORWALK
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06850-4000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-853-1110
Provider Business Practice Location Address Fax Number:
203-853-1359
Provider Enumeration Date:
01/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MALANIAK
Authorized Official First Name:
SARAH
Authorized Official Middle Name:
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
201-742-2555

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  0267 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 490004416 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 004207503 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 353 . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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