Healthcare Provider Details

I. General information

NPI: 1215289525
Provider Name (Legal Business Name): NEW STARLIGHT OPTICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2012
Last Update Date: 10/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 GRAVESEND NECK RD
BROOKLYN NY
11229-4434
US

IV. Provider business mailing address

1501 GRAVESEND NECK RD
BROOKLYN NY
11229-4434
US

V. Phone/Fax

Practice location:
  • Phone: 718-787-4111
  • Fax: 718-787-4114
Mailing address:
  • Phone: 718-787-4111
  • Fax: 718-787-4114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: MARINA GRAYEVSKY
Title or Position: PRESIDENT
Credential:
Phone: 718-787-4111