Provider Demographics
NPI:1720156458
Name:OPHTHALMIC CONSULTANTS OF LONG ISLAND
Entity Type:Organization
Organization Name:OPHTHALMIC CONSULTANTS OF LONG ISLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-872-8309
Mailing Address - Street 1:266 MERRICK RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-2640
Mailing Address - Country:US
Mailing Address - Phone:516-872-8309
Mailing Address - Fax:516-872-2182
Practice Address - Street 1:3742 73RD ST
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-6246
Practice Address - Country:US
Practice Address - Phone:718-426-3736
Practice Address - Fax:718-426-4474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193409174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1245271600OtherNPI GROUP# SUFFOLK
NY1285675660OtherNPI GROUP# NASSAU
NY1245271600OtherNPI GROUP# SUFFOLK