MEDICARE: TRIBECA RETINA SPECIALIST, PC

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	196404	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1275574287	OTHER		NPI TYPE 1

General Provider Information

NPI Number	:	1376834788
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRIBECA RETINA SPECIALIST, PC

Provider Business Mailing Address
First Line	:	77 WORTH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10013-3411
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	77 WORTH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10013-3411
Country	:	US
Telephone Number	:	212-966-3601
Fax Number	:

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	DR. BELINDA SHIRKEY
Credential	:
Telephone Number	:	212-966-3901

Provider Enumeration Date	:	04/20/2011
Last Update Date	:	04/20/2011

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