Healthcare Provider Details

I. General information

NPI: 1114065281
Provider Name (Legal Business Name): OPHTHALMOLOGY ASSOCIATES OF STATEN ISLAND PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 03/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 VICTORY BLVD
STATEN ISLAND NY
10301-3914
US

IV. Provider business mailing address

1460 VICTORY BLVD
STATEN ISLAND NY
10301-3914
US

V. Phone/Fax

Practice location:
  • Phone: 718-447-0022
  • Fax: 718-876-8778
Mailing address:
  • Phone: 718-447-0022
  • Fax: 718-876-8778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. PHILIP W. KRAMER
Title or Position: PRESIDENT
Credential: MD
Phone: 718-447-0022