Provider Demographics
NPI:1336435429
Name:SMOLYAK GLUACOMA CONSULTANT PC
Entity Type:Organization
Organization Name:SMOLYAK GLUACOMA CONSULTANT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMOLYAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-646-2200
Mailing Address - Street 1:7109 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-5316
Mailing Address - Country:US
Mailing Address - Phone:718-646-2200
Mailing Address - Fax:718-646-6623
Practice Address - Street 1:128 MOTT ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-5540
Practice Address - Country:US
Practice Address - Phone:718-646-2200
Practice Address - Fax:718-646-6623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty