1629222641 NPI number — GLAUCOMA ASSOCIATES OF NEW YORK, P.C.

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 1629222641 NPI number — GLAUCOMA ASSOCIATES OF NEW YORK, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GLAUCOMA ASSOCIATES OF NEW YORK, P.C.
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:
1629222641
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
310 E 14TH ST
Provider Second Line Business Mailing Address:
SUITE 304 SO
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10003-4201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-521-0264
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
121 E 60TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10022-1117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-477-7540
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/05/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ABEBE
Authorized Official First Name:
SERKADIS
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLER
Authorized Official Telephone Number:
212-477-7540

Provider Taxonomy Codes

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

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





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