Healthcare Provider Details

I. General information

NPI: 1689317562
Provider Name (Legal Business Name): NYC RETINA SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2022
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10721 QUEENS BLVD STE 9
FOREST HILLS NY
11375-4451
US

IV. Provider business mailing address

10721 QUEENS BLVD STE 9
FOREST HILLS NY
11375-4451
US

V. Phone/Fax

Practice location:
  • Phone: 718-285-7585
  • Fax:
Mailing address:
  • Phone: 718-285-7585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER KWAN
Title or Position: OFFICE ASSISTANT
Credential:
Phone: 718-866-3150