Healthcare Provider Details

I. General information

NPI: 1962591693
Provider Name (Legal Business Name): RETINA GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 09/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 BOSTON RD
BRONX NY
10467-9005
US

IV. Provider business mailing address

2221 BOSTON RD
BRONX NY
10467-9005
US

V. Phone/Fax

Practice location:
  • Phone: 718-798-3030
  • Fax:
Mailing address:
  • Phone: 718-798-3030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: JEREMY CHESS
Title or Position: DIRECTOR
Credential: M.D.
Phone: 718-798-3030