Provider Demographics
NPI:1518099209
Name:DIAMOND DISTRICT CORNEAL, P.C.
Entity Type:Organization
Organization Name:DIAMOND DISTRICT CORNEAL, P.C.
Other - Org Name:COHEN EYE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ILAN
Authorized Official - Middle Name:
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-456-9500
Mailing Address - Street 1:56-50 MYRTLE AVENUE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385
Mailing Address - Country:US
Mailing Address - Phone:718-456-9500
Mailing Address - Fax:718-497-8762
Practice Address - Street 1:56-50 MYRTLE AVENUE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385
Practice Address - Country:US
Practice Address - Phone:718-456-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG400008555OtherMEDICARE INDIVIDUAL PTAN
NYP00818737OtherRAILROAD MEDICARE INDIVIDUAL PTAN
NYDQ1530OtherRAILROAD MEDICARE GROUP PTAN
NY02426864Medicaid
NYWEJ401Medicare PIN
NYG100008554Medicare PIN
NY02426864Medicaid