Provider Demographics
NPI:1609167212
Name:BARTOW AVENUE BRONX EYE CARE INC
Entity Type:Organization
Organization Name:BARTOW AVENUE BRONX EYE CARE INC
Other - Org Name:BRONX EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELAINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAVILENSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-671-5666
Mailing Address - Street 1:2075 BARTOW AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-4613
Mailing Address - Country:US
Mailing Address - Phone:718-671-5666
Mailing Address - Fax:718-862-2306
Practice Address - Street 1:2075 BARTOW AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-4613
Practice Address - Country:US
Practice Address - Phone:718-671-5666
Practice Address - Fax:718-862-2306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-29
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006962152W00000X
NY007938332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100090662Medicare PIN