Provider Demographics
NPI:1396206306
Name:RETINA CONSULTANTS OF WESTCHESTER P.C.
Entity Type:Organization
Organization Name:RETINA CONSULTANTS OF WESTCHESTER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:RADHAKRISHNAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-826-0245
Mailing Address - Street 1:PO BOX 15
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-0015
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:559 GRAMATAN AVE STE 202
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10552-2156
Practice Address - Country:US
Practice Address - Phone:914-699-2020
Practice Address - Fax:914-699-2019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-31
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE