Provider Demographics
NPI:1124214499
Name:OPHTHALMOLOGY ASSOCIATES OF QUEENS PC
Entity Type:Organization
Organization Name:OPHTHALMOLOGY ASSOCIATES OF QUEENS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD PRESIDENT AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HALLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-728-0224
Mailing Address - Street 1:3074 36TH ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-4705
Mailing Address - Country:US
Mailing Address - Phone:718-728-0224
Mailing Address - Fax:718-728-1626
Practice Address - Street 1:3074 36TH ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-4705
Practice Address - Country:US
Practice Address - Phone:718-728-0224
Practice Address - Fax:718-728-1626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01353Medicare PIN