Provider Demographics
NPI:1356315857
Name:FALASCA, NEIL A (OD)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:A
Last Name:FALASCA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 HILLSIDE AVE
Mailing Address - Street 2:SUITE 99I
Mailing Address - City:WILLISTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11596-2333
Mailing Address - Country:US
Mailing Address - Phone:516-798-8812
Mailing Address - Fax:
Practice Address - Street 1:99 HILLSIDE AVE
Practice Address - Street 2:SUITE 99I
Practice Address - City:WILLISTON PARK
Practice Address - State:NY
Practice Address - Zip Code:11596-2333
Practice Address - Country:US
Practice Address - Phone:516-798-8812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT003074152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC26531Medicare PIN