MEDICARE: BROOKLYN EYE SURGERY CENTER LLC

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	261QA1903X	Ambulatory Surgical Clinic/Center

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	:	1730180084
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROOKLYN EYE SURGERY CENTER LLC

Provider Business Mailing Address
First Line	:	1301 AVENUE J
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-3605
Country	:	US
Telephone Number	:	718-645-0600
Fax Number	:	718-692-4456

Provider Business Practice Location Address
First Line	:	1301 AVENUE J
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-3605
Country	:	US
Telephone Number	:	718-645-0600
Fax Number	:	718-692-4456

Authorized Official
Title or Position	:	MANAGING DIRECTOR
Name	:	DR. LEONARD BLEY
Credential	:	M.D.
Telephone Number	:	718-645-0600

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	10/28/2020

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