Provider Demographics
NPI:1972235646
Name:NYNOS P.C.
Entity Type:Organization
Organization Name:NYNOS P.C.
Other - Org Name:NYNOS (NEW YORK NEURO-OPHTHALMOLOGY AND STRABISMUS) P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BOKKWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:919-428-1621
Mailing Address - Street 1:15814 NORTHERN BLVD
Mailing Address - Street 2:STE ML06
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358
Mailing Address - Country:US
Mailing Address - Phone:718-799-0302
Mailing Address - Fax:
Practice Address - Street 1:15814 NORTHERN BLVD
Practice Address - Street 2:ML6
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-1135
Practice Address - Country:US
Practice Address - Phone:919-428-1621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-30
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0109XAllopathic & Osteopathic PhysiciansOphthalmologyNeuro-ophthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05458860Medicaid