Provider Demographics
NPI:1891884581
Name:RETINA GROUP P.C.
Entity Type:Organization
Organization Name:RETINA GROUP P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHESS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-798-3030
Mailing Address - Street 1:2221 BOSTON RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-9005
Mailing Address - Country:US
Mailing Address - Phone:718-798-3030
Mailing Address - Fax:
Practice Address - Street 1:55 E 86TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-1059
Practice Address - Country:US
Practice Address - Phone:718-798-3030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW0Z573Medicare PIN