Provider Demographics
NPI:1366455339
Name:EYE PHYSICIANS AND SURGEONS OF NY, PLLC
Entity Type:Organization
Organization Name:EYE PHYSICIANS AND SURGEONS OF NY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MS
Authorized Official - Phone:718-834-1976
Mailing Address - Street 1:149 PIERREPONT ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-2712
Mailing Address - Country:US
Mailing Address - Phone:718-834-1976
Mailing Address - Fax:718-855-8567
Practice Address - Street 1:2177 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-6603
Practice Address - Country:US
Practice Address - Phone:718-494-9055
Practice Address - Fax:718-494-3713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02501577Medicaid
NYWFB241Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER