MEDICARE: FOCUS RETINA CONSULTANT, 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
1	207W00000X	Ophthalmology Physician	225661	NY

General Provider Information

NPI Number	:	1114172418
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOCUS RETINA CONSULTANT, PLLC

Provider Business Mailing Address
First Line	:	1627 E 21ST ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-5037
Country	:	US
Telephone Number	:	646-256-7201
Fax Number	:	718-951-0693

Provider Business Practice Location Address
First Line	:	1627 E 21ST ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-5037
Country	:	US
Telephone Number	:	646-256-7201
Fax Number	:	718-951-0693

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. MEIR MOSHEH BAALHANESS
Credential	:	MD
Telephone Number	:	646-256-7201

Provider Enumeration Date	:	12/01/2008
Last Update Date	:	12/01/2008

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