1699957944 NPI number — PEN OPTICAL AND ASSOCIATES INC.

Table of content: (NPI 1699957944)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699957944 NPI number — PEN OPTICAL AND ASSOCIATES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEN OPTICAL AND ASSOCIATES 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:
1699957944
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
450 7TH AVE
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10123-0101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-279-4826
Provider Business Mailing Address Fax Number:
212-563-3047

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
450 7TH AVE
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10123-0101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-279-4826
Provider Business Practice Location Address Fax Number:
212-563-3047
Provider Enumeration Date:
11/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TISCH
Authorized Official First Name:
CRAIG
Authorized Official Middle Name:
BRIAN
Authorized Official Title or Position:
OPTOMETRIST
Authorized Official Telephone Number:
212-279-4826

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  TUV0056721 , 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)





Copyright © 2007-2025 www.npivalidator.com