Provider Demographics
NPI:1558501213
Name:NATHAN BOLDUR MD PLLC
Entity Type:Organization
Organization Name:NATHAN BOLDUR MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLDUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-636-1182
Mailing Address - Street 1:115 EASTERN PKWY
Mailing Address - Street 2:STE 1G
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-6086
Mailing Address - Country:US
Mailing Address - Phone:718-636-1182
Mailing Address - Fax:718-638-8588
Practice Address - Street 1:115 EASTERN PKWY
Practice Address - Street 2:STE 1G
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-6085
Practice Address - Country:US
Practice Address - Phone:718-636-1182
Practice Address - Fax:718-638-8588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205589207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty