Provider Demographics
NPI:1528043734
Name:SPECS FOR LESS OF THIRD AVE
Entity Type:Organization
Organization Name:SPECS FOR LESS OF THIRD AVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:L
Authorized Official - Last Name:KIRSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-831-3162
Mailing Address - Street 1:1904 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-4601
Mailing Address - Country:US
Mailing Address - Phone:212-831-3162
Mailing Address - Fax:
Practice Address - Street 1:1904 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-4601
Practice Address - Country:US
Practice Address - Phone:212-831-3162
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4792156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01178096Medicaid