Provider Demographics
NPI:1457490518
Name:ASSOCIATES IN VISION REHABILITATION, INC.
Entity type:Organization
Organization Name:ASSOCIATES IN VISION REHABILITATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:O
Authorized Official - Last Name:MENDELSOHN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:212-986-2153
Mailing Address - Street 1:130 EAST 40TH ST.
Mailing Address - Street 2:SUITE 1204
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:212-986-2153
Mailing Address - Fax:212-986-0398
Practice Address - Street 1:130 EAST 40TH ST.
Practice Address - Street 2:SUITE 1204
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:212-986-2153
Practice Address - Fax:212-986-0398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV003902-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0320750001Medicare NSC
NYT48957Medicare UPIN
NYWZXWV1Medicare PIN