Provider Demographics
NPI:1740380419
Name:MIDWOOD FAMILY VISION
Entity Type:Organization
Organization Name:MIDWOOD FAMILY VISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:718-375-4300
Mailing Address - Street 1:1714 AVENUE M
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-5304
Mailing Address - Country:US
Mailing Address - Phone:718-375-4300
Mailing Address - Fax:
Practice Address - Street 1:1714 AVENUE M
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-5304
Practice Address - Country:US
Practice Address - Phone:718-375-4300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-23
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC006707-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1000350000OtherUFT
NY02040646Medicaid
NY14592OtherSPECTERA
NY02040646Medicaid
NY1310480001Medicare NSC