Provider Demographics
NPI:1013020296
Name:NEW YORK GLAUCOMA MEDICAL PC
Entity Type:Organization
Organization Name:NEW YORK GLAUCOMA MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PANKOVA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:718-645-2201
Mailing Address - Street 1:65 OCEANA DR E
Mailing Address - Street 2:SUITE 5D
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6686
Mailing Address - Country:US
Mailing Address - Phone:718-645-2201
Mailing Address - Fax:718-645-2207
Practice Address - Street 1:455 KINGS HWY
Practice Address - Street 2:1ST FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-1803
Practice Address - Country:US
Practice Address - Phone:718-645-2201
Practice Address - Fax:718-645-2207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty