Provider Demographics
NPI:1821140757
Name:ROELOFFS INC.
Entity Type:Organization
Organization Name:ROELOFFS INC.
Other - Org Name:KURT W. ROELOFFS
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:A
Authorized Official - Last Name:EBEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-329-2020
Mailing Address - Street 1:9 BARNS LN
Mailing Address - Street 2:
Mailing Address - City:EAST HAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11937-2201
Mailing Address - Country:US
Mailing Address - Phone:631-329-2020
Mailing Address - Fax:631-324-3310
Practice Address - Street 1:9 BARNS LN
Practice Address - Street 2:
Practice Address - City:EAST HAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11937-2201
Practice Address - Country:US
Practice Address - Phone:631-329-2020
Practice Address - Fax:631-324-3310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYUT002797152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100001098Medicare PIN
NY6161130001Medicare NSC