Healthcare Provider Details

I. General information

NPI: 1093852766
Provider Name (Legal Business Name): VIOLA KANEVSKY, O.D., P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 COLUMBUS AVE
NEW YORK NY
10024-3402
US

IV. Provider business mailing address

527 COLUMBUS AVE
NEW YORK NY
10024-3402
US

V. Phone/Fax

Practice location:
  • Phone: 212-580-2020
  • Fax: 212-580-2023
Mailing address:
  • Phone: 212-580-2020
  • Fax: 212-580-2023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT005443
License Number StateNY

VIII. Authorized Official

Name: DR. VIOLA KANEVSKY
Title or Position: SOLE MEMBER
Credential: O.D.
Phone: 212-580-2020