Provider Demographics
NPI:1255646212
Name:LONG ISLAND OPHTHALMOLOGY & EYE SURGERY, P. C.
Entity type:Organization
Organization Name:LONG ISLAND OPHTHALMOLOGY & EYE SURGERY, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMIDENKO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:718-868-8668
Mailing Address - Street 1:1731 SEAGIRT BLVD
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-4513
Mailing Address - Country:US
Mailing Address - Phone:718-868-8668
Mailing Address - Fax:718-868-8611
Practice Address - Street 1:1731 SEAGIRT BLVD
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-4513
Practice Address - Country:US
Practice Address - Phone:718-868-8668
Practice Address - Fax:718-868-8611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-15
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY249146207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG100037991Medicare PIN
NYA100041133Medicare PIN