Provider Demographics
NPI:1700053907
Name:QUEENS PLAZA OPTICAL
Entity Type:Organization
Organization Name:QUEENS PLAZA OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:
Authorized Official - Last Name:SIONOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-482-7462
Mailing Address - Street 1:2724 QUEENS PLZ S
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-4102
Mailing Address - Country:US
Mailing Address - Phone:718-482-7462
Mailing Address - Fax:718-482-7462
Practice Address - Street 1:2724 QUEENS PLZ S
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-4102
Practice Address - Country:US
Practice Address - Phone:718-482-7462
Practice Address - Fax:718-482-7462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007688-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty