Provider Demographics
NPI:1780892752
Name:CITY SPEC, INC.
Entity type:Organization
Organization Name:CITY SPEC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:KOLKMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-666-5840
Mailing Address - Street 1:185 KISCO AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-1409
Mailing Address - Country:US
Mailing Address - Phone:914-666-5840
Mailing Address - Fax:914-242-7209
Practice Address - Street 1:185 KISCO AVE
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-1409
Practice Address - Country:US
Practice Address - Phone:914-666-5840
Practice Address - Fax:914-242-7209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4304010001Medicare NSC