Provider Demographics
NPI:1780922914
Name:MAPLE EYE AND LASER OPHTHALMOLOGY, PC
Entity type:Organization
Organization Name:MAPLE EYE AND LASER OPHTHALMOLOGY, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:STRONG
Authorized Official - Last Name:KORNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-948-5157
Mailing Address - Street 1:61 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-5106
Mailing Address - Country:US
Mailing Address - Phone:914-948-5157
Mailing Address - Fax:
Practice Address - Street 1:20 E 46TH ST RM 501
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-9284
Practice Address - Country:US
Practice Address - Phone:914-948-5157
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAPLE EYE AND LASER OPHTHALMOLOGY, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204042207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWWP861Medicare PIN