Provider Demographics
NPI:1912176355
Name:SAMUEL HERBST
Entity Type:Organization
Organization Name:SAMUEL HERBST
Other - Org Name:M. S. OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BENZION
Authorized Official - Middle Name:
Authorized Official - Last Name:HERBST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-436-5900
Mailing Address - Street 1:5202 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-1408
Mailing Address - Country:US
Mailing Address - Phone:718-436-5900
Mailing Address - Fax:718-854-0570
Practice Address - Street 1:5202 16TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-1408
Practice Address - Country:US
Practice Address - Phone:718-436-5900
Practice Address - Fax:718-854-0570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC003535-1332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier