1386763183 NPI number — WHITE PLAINS EYE SURGERY

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 1386763183 NPI number — WHITE PLAINS EYE SURGERY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WHITE PLAINS EYE SURGERY
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:
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:
1386763183
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
75 LINDA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITE PLAINS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-681-0900
Provider Business Mailing Address Fax Number:
914-681-9201

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 LINDA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITE PLAINS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-681-0900
Provider Business Practice Location Address Fax Number:
914-681-9201
Provider Enumeration Date:
03/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PISACANO
Authorized Official First Name:
KRISTIN
Authorized Official Middle Name:
Authorized Official Title or Position:
MD PRESIDENT
Authorized Official Telephone Number:
914-681-0900

Provider Taxonomy Codes

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

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





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