Provider Demographics
NPI:1245660075
Name:NORTHEAST EYE SURGEONS PA
Entity type:Organization
Organization Name:NORTHEAST EYE SURGEONS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M. D/PART OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:YEROUSHALMI
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:855-876-2020
Mailing Address - Street 1:920 REVOLUTION ST
Mailing Address - Street 2:
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-3748
Mailing Address - Country:US
Mailing Address - Phone:855-876-2020
Mailing Address - Fax:302-734-1921
Practice Address - Street 1:920 REVOLUTION ST
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-3748
Practice Address - Country:US
Practice Address - Phone:855-876-2020
Practice Address - Fax:302-734-1921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-14
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD76762207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty