Provider Demographics
NPI:1639355639
Name:CLAIRMONT-NICHOLS OF FIRST AVENUE INC.
Entity type:Organization
Organization Name:CLAIRMONT-NICHOLS OF FIRST AVENUE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:MALSIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-758-2346
Mailing Address - Street 1:1016 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4107
Mailing Address - Country:US
Mailing Address - Phone:212-758-2346
Mailing Address - Fax:212-750-3583
Practice Address - Street 1:1016 1ST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4107
Practice Address - Country:US
Practice Address - Phone:212-758-2346
Practice Address - Fax:212-750-3583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-21
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04442332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
1639355639OtherNPI
1366634131OtherNPI
1366634131OtherNPI