Provider Demographics
NPI:1356523989
Name:DR. JULIUS KORNBERG, P.L.L.C.
Entity type:Organization
Organization Name:DR. JULIUS KORNBERG, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:LACORTE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:516-627-0208
Mailing Address - Street 1:433 PLANDOME RD
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-1942
Mailing Address - Country:US
Mailing Address - Phone:516-627-0208
Mailing Address - Fax:516-627-2929
Practice Address - Street 1:433 PLANDOME RD
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-1942
Practice Address - Country:US
Practice Address - Phone:516-627-0208
Practice Address - Fax:516-627-2929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT2523152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4846550001Medicare NSC