Provider Demographics
NPI:1841274016
Name:RETINA CONSULTANT, PLLC
Entity type:Organization
Organization Name:RETINA CONSULTANT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAOMI
Authorized Official - Middle Name:S
Authorized Official - Last Name:FALK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-533-6550
Mailing Address - Street 1:PO BOX 668
Mailing Address - Street 2:
Mailing Address - City:SLINGERLANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12159-0668
Mailing Address - Country:US
Mailing Address - Phone:518-533-6550
Mailing Address - Fax:518-533-6556
Practice Address - Street 1:1220 NEW SCOTLAND RD
Practice Address - Street 2:SUITE 201
Practice Address - City:SLINGERLANDS
Practice Address - State:NY
Practice Address - Zip Code:12159
Practice Address - Country:US
Practice Address - Phone:518-533-6550
Practice Address - Fax:518-533-6556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-01
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCK2870OtherRAILROAD MEDICARE
NYAA1201Medicare PIN