Provider Demographics
NPI:1508953761
Name:GARDEN CITY OPHTHALMOLOGY, PC
Entity Type:Organization
Organization Name:GARDEN CITY OPHTHALMOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SRILATA
Authorized Official - Middle Name:SRIRAM
Authorized Official - Last Name:NAIDU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-665-9661
Mailing Address - Street 1:877 STEWART AVE
Mailing Address - Street 2:SUITE 12
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-4803
Mailing Address - Country:US
Mailing Address - Phone:516-665-9661
Mailing Address - Fax:516-208-3506
Practice Address - Street 1:877 STEWART AVE
Practice Address - Street 2:SUITE 12
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4803
Practice Address - Country:US
Practice Address - Phone:516-665-9661
Practice Address - Fax:516-208-3506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210490207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH75653Medicare UPIN