Provider Demographics
NPI:1467656355
Name:GLAUCOMA MEDICAL CONSULTANTS OF NEW YORK, PLLC
Entity Type:Organization
Organization Name:GLAUCOMA MEDICAL CONSULTANTS OF NEW YORK, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLER
Authorized Official - Prefix:MISS
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-718-7478
Mailing Address - Street 1:2148 OCEAN AVE STE 603
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1485
Mailing Address - Country:US
Mailing Address - Phone:718-339-5100
Mailing Address - Fax:718-339-2648
Practice Address - Street 1:2148 OCEAN AVE STE 603
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1485
Practice Address - Country:US
Practice Address - Phone:718-339-5100
Practice Address - Fax:718-339-2648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04809Medicare PIN
NYW32691Medicare ID - Type Unspecified