Provider Demographics
NPI:1972747277
Name:CENTRAL NASSAU OPTOMETRIC CONSULTANT P.C.
Entity Type:Organization
Organization Name:CENTRAL NASSAU OPTOMETRIC CONSULTANT P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IRA
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:516-481-2020
Mailing Address - Street 1:112 FULTON AVE
Mailing Address - Street 2:B
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-3752
Mailing Address - Country:US
Mailing Address - Phone:516-481-2050
Mailing Address - Fax:516-307-3305
Practice Address - Street 1:112 FULTON AVE
Practice Address - Street 2:B
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-3752
Practice Address - Country:US
Practice Address - Phone:516-481-2050
Practice Address - Fax:516-307-3305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005281-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty