Provider Demographics
NPI:1932279213
Name:MY OPHTHALMOLOGIST, P.C.
Entity Type:Organization
Organization Name:MY OPHTHALMOLOGIST, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURROWS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-396-1188
Mailing Address - Street 1:425 MADISON AVE
Mailing Address - Street 2:SUITE 802
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-1110
Mailing Address - Country:US
Mailing Address - Phone:212-396-1188
Mailing Address - Fax:212-755-8479
Practice Address - Street 1:425 MADISON AVE
Practice Address - Street 2:SUITE 802
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-1110
Practice Address - Country:US
Practice Address - Phone:212-396-1188
Practice Address - Fax:212-755-8479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY163544207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01024780Medicaid
NY01024780Medicaid
NY09F661Medicare ID - Type Unspecified