MEDICARE: NA MA 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
1	261QS0132X	Ophthalmologic Surgery Clinic/Center	250375	NY

General Provider Information

NPI Number	:	1396023891
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NA MA OPHTHALMOLOGY PLLC

Provider Business Mailing Address
First Line	:	39 KINGS POINT RD
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11024-1635
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	39 KINGS POINT RD
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11024-1635
Country	:	US
Telephone Number	:	516-305-7152
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. NA MA
Credential	:	M.D.
Telephone Number	:	516-504-3867

Provider Enumeration Date	:	08/01/2011
Last Update Date	:	08/01/2011

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