Healthcare Provider Details

I. General information

NPI: 1528116282
Provider Name (Legal Business Name): MDA MANAGEMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4526 BROADWAY
NEW YORK NY
10040-2404
US

IV. Provider business mailing address

4526 BROADWAY
NEW YORK NY
10040-2404
US

V. Phone/Fax

Practice location:
  • Phone: 212-304-3585
  • Fax:
Mailing address:
  • Phone: 212-304-3585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV 006977
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number007305-1
License Number StateNY

VIII. Authorized Official

Name: LUIDMILA SAPERSON
Title or Position: PRESIDENT
Credential:
Phone: 212-304-3585