1447501036 NPI number — NASSAU COUNTY OPHTHALMOLOGY PC

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 1447501036 NPI number — NASSAU COUNTY OPHTHALMOLOGY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NASSAU COUNTY OPHTHALMOLOGY PC
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:
1447501036
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22 BAYBERRY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAWRENCE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11559-2705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-239-6789
Provider Business Mailing Address Fax Number:
516-239-5023

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1229 BROADWAY
Provider Second Line Business Practice Location Address:
STE 210
Provider Business Practice Location Address City Name:
HEWLETT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11557-2014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-239-6789
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/24/2012

Additional Information

Authorized Official

Authorized Official Last Name:
SAFFRA
Authorized Official First Name:
NORMAN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
516-239-6789

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  179379 , 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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