Provider Demographics
NPI:1396849584
Name:NEW YORK CORNEA, PLLC
Entity Type:Organization
Organization Name:NEW YORK CORNEA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPHTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:I
Authorized Official - Last Name:FAN-PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-305-3378
Mailing Address - Street 1:635 W 165TH ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3724
Mailing Address - Country:US
Mailing Address - Phone:212-305-3378
Mailing Address - Fax:212-781-1188
Practice Address - Street 1:635 W 165TH ST
Practice Address - Street 2:SUITE 303
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3724
Practice Address - Country:US
Practice Address - Phone:212-305-3378
Practice Address - Fax:212-781-1188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204187-1207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG95707Medicare UPIN
NYWEU291Medicare ID - Type Unspecified