Healthcare Provider Details

I. General information

NPI: 1962513721
Provider Name (Legal Business Name): EYE MEDICAL P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 BARTOW AVE SUITE 216C
BRONX NY
10475-4614
US

IV. Provider business mailing address

2100 BARTOW AVE SUITE 216C
BRONX NY
10475-4614
US

V. Phone/Fax

Practice location:
  • Phone: 718-862-3937
  • Fax: 646-349-3252
Mailing address:
  • Phone: 718-862-3937
  • Fax: 646-349-3252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number226327
License Number StateNY

VIII. Authorized Official

Name: DR. GARY R FISHMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 718-862-3937