Provider Demographics
NPI:1780854265
Name:BROOKLYN MEDICAL EYE ASSOCIATE, LLC
Entity Type:Organization
Organization Name:BROOKLYN MEDICAL EYE ASSOCIATE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KANAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAROT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-693-0700
Mailing Address - Street 1:300 JERICHO QUADRANGLE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-2720
Mailing Address - Country:US
Mailing Address - Phone:516-693-0700
Mailing Address - Fax:516-693-0271
Practice Address - Street 1:2460 FLATBUSH AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5000
Practice Address - Country:US
Practice Address - Phone:718-252-1200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY105162207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW33571Medicare PIN