MEDICARE: RETINA GROUP P.C.

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

General Provider Information

NPI Number	:	1326137951
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RETINA GROUP P.C.

Provider Business Mailing Address
First Line	:	2221 BOSTON RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-9005
Country	:	US
Telephone Number	:	718-798-3030
Fax Number	:

Provider Business Practice Location Address
First Line	:	1915 NEW HYDE PARK RD
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11040-2028
Country	:	US
Telephone Number	:	718-798-3030
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	JEREMY CHESS
Credential	:	M.D.
Telephone Number	:	718-798-3030

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	09/18/2007

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