Provider Demographics
NPI:1912320052
Name:FORT GREEN VISION CORP
Entity Type:Organization
Organization Name:FORT GREEN VISION CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ROZHANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-306-5191
Mailing Address - Street 1:446B MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-2414
Mailing Address - Country:US
Mailing Address - Phone:718-246-2020
Mailing Address - Fax:347-987-4335
Practice Address - Street 1:446B MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-2414
Practice Address - Country:US
Practice Address - Phone:718-246-2020
Practice Address - Fax:347-987-4335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-25
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006307156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty