Healthcare Provider Details

I. General information

NPI: 1528043734
Provider Name (Legal Business Name): SPECS FOR LESS OF THIRD AVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1904 3RD AVE
NEW YORK NY
10029-4601
US

IV. Provider business mailing address

1904 3RD AVE
NEW YORK NY
10029-4601
US

V. Phone/Fax

Practice location:
  • Phone: 212-831-3162
  • Fax:
Mailing address:
  • Phone: 212-831-3162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number4792
License Number StateNY

VIII. Authorized Official

Name: MR. JEFFREY L. KIRSCH
Title or Position: OWNER
Credential:
Phone: 212-831-3162