MEDICARE: OPHTHALMIC CONSULTANTS OF OPHTHALMOLOGY, 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538450192
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPHTHALMIC CONSULTANTS OF OPHTHALMOLOGY, PC

Provider Business Mailing Address
First Line	:	940 PARK AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10028-0311
Country	:	US
Telephone Number	:	212-570-6300
Fax Number	:	212-472-4524

Provider Business Practice Location Address
First Line	:	940 PARK AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10028-0311
Country	:	US
Telephone Number	:	212-570-6300
Fax Number	:	212-472-4524

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JONATHAN M KAGAN
Credential	:	MD
Telephone Number	:	212-570-6300

Provider Enumeration Date	:	04/29/2011
Last Update Date	:	04/29/2011

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