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NPI Code Detail

MEDICARE: BROOKLYN OPHTHALMOLOGY PLLC

MEDICARE: BROOKLYN OPHTHALMOLOGY PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207W00000XOphthalmology Physician206436NY

General Provider Information

NPI Number : 1104205780
Entity Type Code : Organization
Provider Name (Legal Business Name) : BROOKLYN OPHTHALMOLOGY PLLC
Provider Business Mailing Address
First Line : 18 FRANKLIN PL
Second Line :
City : GREAT NECK
State : NY
Zip : 11023-1229
Country : US
Telephone Number : 718-287-2020
Fax Number : 718-287-2026
Provider Business Practice Location Address
First Line : 4014 CHURCH AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11203-2917
Country : US
Telephone Number : 718-287-2020
Fax Number : 516-829-2026
Authorized Official
Title or Position : CEO PRESIDENT
Name : DR. DANIEL K KHODADADIAN
Credential : MD
Telephone Number : 718-287-2020
Provider Enumeration Date : 05/28/2015
Last Update Date : 01/25/2024

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Directions to “BROOKLYN OPHTHALMOLOGY PLLC ” Practice Location

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