Provider Demographics
NPI:1508864364
Name:MEDOW, NORMAN BRET (MD)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:BRET
Last Name:MEDOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 E 210TH STREET
Mailing Address - Street 2:MONTEFIORE MEDICAL CENTER DEPARTMENT OF OPHTHALMOLOGY
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467
Mailing Address - Country:US
Mailing Address - Phone:718-920-2020
Mailing Address - Fax:
Practice Address - Street 1:3332 ROCHAMBEAU AVE
Practice Address - Street 2:ROOM 306
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2836
Practice Address - Country:US
Practice Address - Phone:718-920-4609
Practice Address - Fax:718-881-5439
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY099393207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2127300OtherAETNA USHEALTHCARE
NYP2073780OtherOXFORD
NY132760994OtherGUARDIAN PHCS
NY132760994OtherMULTIPLAN
NY132760994OtherEMPIRE BLUE CR/BLUE SH
NY00169791Medicaid
NY05710POtherHIP
NY132760994OtherSTOREWORKERS
NY132760994OtherNEW YORK HOTEL TRADE
NY181922385OtherR.R. MEDICARE
NY181922385OtherR.R. MEDICARE
NY132760994OtherSTOREWORKERS