Provider Demographics
NPI:1093961260
Name:GEORGE KANDEL ,OPTOMETRY,P.C.
Entity Type:Organization
Organization Name:GEORGE KANDEL ,OPTOMETRY,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:ALEX
Authorized Official - Last Name:KANDEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:718-843-2156
Mailing Address - Street 1:12015 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11419-2117
Mailing Address - Country:US
Mailing Address - Phone:718-843-2156
Mailing Address - Fax:
Practice Address - Street 1:12015 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:SOUTH RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11419-2117
Practice Address - Country:US
Practice Address - Phone:718-843-2156
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV 003560-1261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00329117Medicaid
NY93000Medicare PIN
NY0416700001Medicare NSC