Provider Demographics
NPI:1164665469
Name:BRONX OPHTHALMOLOGY PC.
Entity Type:Organization
Organization Name:BRONX OPHTHALMOLOGY PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NATHALIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:DE OLIVEIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-824-1560
Mailing Address - Street 1:1739 WILLIAMSBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461
Mailing Address - Country:US
Mailing Address - Phone:718-824-1560
Mailing Address - Fax:718-409-5213
Practice Address - Street 1:1739 WILLIAMSBRIDGE RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461
Practice Address - Country:US
Practice Address - Phone:718-824-1560
Practice Address - Fax:718-409-5213
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRONX OPHTHALMOLOGY P.C
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-16
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133418174400000X
NY254436174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A10017289Medicare PIN