Provider Demographics
NPI:1164835831
Name:SNG LABS-SNG PROSTHETIC EYE INSTITUTE, INC.
Entity Type:Organization
Organization Name:SNG LABS-SNG PROSTHETIC EYE INSTITUTE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARONZIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-391-7099
Mailing Address - Street 1:16244 S MILITARY TRL STE 420
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6505
Mailing Address - Country:US
Mailing Address - Phone:561-391-7099
Mailing Address - Fax:561-354-5367
Practice Address - Street 1:1118 S ORANGE AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1200
Practice Address - Country:US
Practice Address - Phone:561-391-7099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-10
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL950376500Medicaid
FL0453300001Medicare NSC