Provider Demographics
NPI:1629278643
Name:GREATER NEW YORK OPHTHALMOLOGY CARE, PLLC
Entity Type:Organization
Organization Name:GREATER NEW YORK OPHTHALMOLOGY CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:FATEH
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-490-6522
Mailing Address - Street 1:4141 51ST ST
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-4431
Mailing Address - Country:US
Mailing Address - Phone:718-505-0100
Mailing Address - Fax:717-505-0101
Practice Address - Street 1:4141 51ST ST
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-4431
Practice Address - Country:US
Practice Address - Phone:718-505-0100
Practice Address - Fax:717-505-0101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY224032261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1356390488OtherNPI
NY02802091Medicaid
NY07759OtherMEDICARE
NYH12160Medicare UPIN