Healthcare Provider Details

I. General information

NPI: 1700540077
Provider Name (Legal Business Name): NEW YORK EYE AND GLAUCOMA SPECIALIST PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2021
Last Update Date: 04/03/2022
Certification Date: 04/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13636 39TH AVE STE 2
FLUSHING NY
11354-5576
US

IV. Provider business mailing address

42 GLENWOOD RD
ROSLYN NY
11576-1029
US

V. Phone/Fax

Practice location:
  • Phone: 646-530-8400
  • Fax: 410-657-6888
Mailing address:
  • Phone: 347-724-1896
  • Fax: 410-657-6888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number
License Number State

VIII. Authorized Official

Name: YUFEI TU
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 347-724-1896