Provider Demographics
NPI:1114065281
Name:OPHTHALMOLOGY ASSOCIATES OF STATEN ISLAND PC
Entity Type:Organization
Organization Name:OPHTHALMOLOGY ASSOCIATES OF STATEN ISLAND PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:W
Authorized Official - Last Name:KRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-447-0022
Mailing Address - Street 1:1460 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-3914
Mailing Address - Country:US
Mailing Address - Phone:718-447-0022
Mailing Address - Fax:718-876-8778
Practice Address - Street 1:1460 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-3914
Practice Address - Country:US
Practice Address - Phone:718-447-0022
Practice Address - Fax:718-876-8778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW11891Medicare UPIN