Provider Demographics
NPI:1275876500
Name:NATALIA POTAPOVA OPHTHALMOLOGY PLLC
Entity Type:Organization
Organization Name:NATALIA POTAPOVA OPHTHALMOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:POTAPOVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-215-3687
Mailing Address - Street 1:25 5TH AVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4307
Mailing Address - Country:US
Mailing Address - Phone:917-215-3687
Mailing Address - Fax:917-591-0604
Practice Address - Street 1:25 5TH AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4307
Practice Address - Country:US
Practice Address - Phone:917-215-3687
Practice Address - Fax:917-591-0604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-04
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY255889207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty