Healthcare Provider Details

I. General information

NPI: 1407092489
Provider Name (Legal Business Name): E&I DANELLI DIAMONDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2008
Last Update Date: 11/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

298 7TH AVE STOREFRONT
BROOKLYN NY
11215-3621
US

IV. Provider business mailing address

298 7TH AVE
BROOKLYN NY
11215-3621
US

V. Phone/Fax

Practice location:
  • Phone: 718-768-3939
  • Fax:
Mailing address:
  • Phone: 718-768-3939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV004384
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number008887-1
License Number StateNY

VIII. Authorized Official

Name: MR. ILAN DAVIDOV
Title or Position: PRESIDENT
Credential:
Phone: 718-768-3939