Provider Demographics
NPI:1477546307
Name:LAKE SUCCESS OPHTHALMIC ASSOCIATES PC
Entity Type:Organization
Organization Name:LAKE SUCCESS OPHTHALMIC ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MALKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-488-2750
Mailing Address - Street 1:410 LAKEVILLE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1101
Mailing Address - Country:US
Mailing Address - Phone:516-488-2750
Mailing Address - Fax:516-488-7407
Practice Address - Street 1:410 LAKEVILLE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1101
Practice Address - Country:US
Practice Address - Phone:516-488-2750
Practice Address - Fax:516-488-7407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-25
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW04211Medicare UPIN
NY09557Medicare PIN