Healthcare Provider Details

I. General information

NPI: 1730180084
Provider Name (Legal Business Name): BROOKLYN EYE SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 AVENUE J
BROOKLYN NY
11230-3605
US

IV. Provider business mailing address

1301 AVENUE J
BROOKLYN NY
11230-3605
US

V. Phone/Fax

Practice location:
  • Phone: 718-645-0600
  • Fax: 718-692-4456
Mailing address:
  • Phone: 718-645-0600
  • Fax: 718-692-4456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. LEONARD BLEY
Title or Position: MANAGING DIRECTOR
Credential: M.D.
Phone: 718-645-0600