Provider Demographics
NPI:1962510560
Name:NEW YORK OPTICAL OF MANHATTAN CORPORATION
Entity Type:Organization
Organization Name:NEW YORK OPTICAL OF MANHATTAN CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:TABACHNICK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:212-927-4444
Mailing Address - Street 1:65 VILLAS CIR
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-3061
Mailing Address - Country:US
Mailing Address - Phone:212-927-4444
Mailing Address - Fax:
Practice Address - Street 1:648 W 181ST ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-3801
Practice Address - Country:US
Practice Address - Phone:212-927-4444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV002974152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02104263Medicaid
NYCOW732Medicare ID - Type Unspecified