Provider Demographics
NPI:1184631152
Name:MAHOPAC OPHTHALMOLOGY PC
Entity Type:Organization
Organization Name:MAHOPAC OPHTHALMOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-628-8788
Mailing Address - Street 1:7 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541-2219
Mailing Address - Country:US
Mailing Address - Phone:845-628-8788
Mailing Address - Fax:845-628-9581
Practice Address - Street 1:7 MILLER RD
Practice Address - Street 2:
Practice Address - City:MAHOPAC
Practice Address - State:NY
Practice Address - Zip Code:10541-2219
Practice Address - Country:US
Practice Address - Phone:845-628-8788
Practice Address - Fax:845-628-9581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW86861Medicare PIN
NY6349720001Medicare NSC