Provider Demographics
NPI:1407092489
Name:E&I DANELLI DIAMONDS INC
Entity Type:Organization
Organization Name:E&I DANELLI DIAMONDS INC
Other - Org Name:COHEN'S FASHION OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ILAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIDOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-768-3939
Mailing Address - Street 1:298 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-3621
Mailing Address - Country:US
Mailing Address - Phone:718-768-3939
Mailing Address - Fax:
Practice Address - Street 1:298 7TH AVE
Practice Address - Street 2:STOREFRONT
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-3621
Practice Address - Country:US
Practice Address - Phone:718-768-3939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-23
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV004384152W00000X
NY008887-1332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100019351Medicare PIN
NY6333530001Medicare NSC