Provider Demographics
NPI:1578570198
Name:STATEN ISLAND OPHTHALMOLOGY, PC
Entity Type:Organization
Organization Name:STATEN ISLAND OPHTHALMOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:KUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-948-8880
Mailing Address - Street 1:23 OCEANIC AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-6511
Mailing Address - Country:US
Mailing Address - Phone:718-948-8880
Mailing Address - Fax:718-967-6040
Practice Address - Street 1:23 OCEANIC AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-6511
Practice Address - Country:US
Practice Address - Phone:718-948-8880
Practice Address - Fax:718-967-6040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW4V841OtherMEDICARE PTAN
NYW4V841OtherMEDICARE PTAN
NJ099474Medicare PIN
U93127Medicare UPIN
NYF23912Medicare UPIN