MEDICARE: EYE SURGERY & AESTHETICS 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	229403	NY

General Provider Information

NPI Number	:	1396912895
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE SURGERY & AESTHETICS PC

Provider Business Mailing Address
First Line	:	35 COVERLY AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10301-4549
Country	:	US
Telephone Number	:	718-448-0588
Fax Number	:

Provider Business Practice Location Address
First Line	:	35 COVERLY AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10301-4549
Country	:	US
Telephone Number	:	718-448-0588
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. NATALIE BORODOKER
Credential	:	M.D.
Telephone Number	:	718-517-2555

Provider Enumeration Date	:	05/13/2008
Last Update Date	:	08/20/2010

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