Provider Demographics
NPI:1710953369
Name:SCHENECTADY OPHTHALMOLOGY ASSOC PC
Entity Type:Organization
Organization Name:SCHENECTADY OPHTHALMOLOGY ASSOC PC
Other - Org Name:DENNIS F CORBETT MD
Other - Org Type:Other Name
Authorized Official - Title/Position:MD PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:F
Authorized Official - Last Name:CORBETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-374-4541
Mailing Address - Street 1:650 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12305
Mailing Address - Country:US
Mailing Address - Phone:518-374-4541
Mailing Address - Fax:518-374-0861
Practice Address - Street 1:650 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12305
Practice Address - Country:US
Practice Address - Phone:518-374-4541
Practice Address - Fax:518-374-0861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY099597207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00527160Medicaid
NY00527160Medicaid
NY00527160Medicaid
50654AMedicare PIN