Healthcare Provider Details

I. General information

NPI: 1114950094
Provider Name (Legal Business Name): PAUL J KANTROWICH O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 LEXINGTON AVE
NEW YORK NY
10170-0002
US

IV. Provider business mailing address

420 LEXINGTON AVE
NEW YORK NY
10170-0002
US

V. Phone/Fax

Practice location:
  • Phone: 212-697-0777
  • Fax: 212-557-4414
Mailing address:
  • Phone: 212-697-0777
  • Fax: 212-557-4414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberTUV003325-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: