Provider Demographics
NPI:1184796591
Name:HIGHLAND OPHTHALMOLOGY ASSOCIATES LLC
Entity type:Organization
Organization Name:HIGHLAND OPHTHALMOLOGY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:J
Authorized Official - Last Name:INGERSOLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-562-0138
Mailing Address - Street 1:104 EXECUTIVE DRIVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553
Mailing Address - Country:US
Mailing Address - Phone:845-562-0138
Mailing Address - Fax:845-562-0147
Practice Address - Street 1:104 EXECUTIVE DRIVE
Practice Address - Street 2:SUITE 300
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553
Practice Address - Country:US
Practice Address - Phone:845-562-0138
Practice Address - Fax:845-562-0147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02773480Medicaid
NY02773480Medicaid
NY4612580001Medicare NSC