1386794980 NPI number — NEW VISION CATARACT CENTER LLC

Table of content: (NPI 1386794980)

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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