Provider Demographics
NPI:1235281205
Name:IWANT2020 COM INC
Entity Type:Organization
Organization Name:IWANT2020 COM INC
Other - Org Name:PARK AVENUE LASEK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMIL
Authorized Official - Middle Name:W
Authorized Official - Last Name:CHYNN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-741-8626
Mailing Address - Street 1:333 PARK AVE S
Mailing Address - Street 2:1ST. FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-2906
Mailing Address - Country:US
Mailing Address - Phone:212-741-8628
Mailing Address - Fax:212-741-2390
Practice Address - Street 1:102 E 25TH ST
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-2906
Practice Address - Country:US
Practice Address - Phone:212-741-8628
Practice Address - Fax:212-741-2390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206774207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01788921Medicaid
NY91T901Medicare ID - Type Unspecified
NY01788921Medicaid