1396205282 NPI number — WHITE PLAINS EYE CARE 1 INC

Table of content: (NPI 1396205282)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396205282 NPI number — WHITE PLAINS EYE CARE 1 INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WHITE PLAINS EYE CARE 1 INC
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:
1396205282
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
598 TUCKAHOE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YONKERS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10710-5713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-337-7775
Provider Business Mailing Address Fax Number:
718-504-4960

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 N BROADWAY
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:
10601-2214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-732-1732
Provider Business Practice Location Address Fax Number:
718-504-4960
Provider Enumeration Date:
03/25/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RUBINFELD
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
805-280-1776

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1073885554 . This is a "OPTOMETRY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1619190915 . This is a "OPTOMETRY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".