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General NPI Number Information
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NPI Number | 1114721396
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Entity Type | Organization
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Legal Business Name | RETINA SPECIALISTS OF NEW YORK, PLLC
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Dates
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Enumeration Date | 04/04/2025
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Last Update Date | 04/04/2025
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Provider Practice Location Address
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Address Line | 17017 NORTHERN BLVD
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City | FLUSHING
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State | NY
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Zip | 11358-2709
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Country | US
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Telephone | 718-539-6000
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Fax | 718-539-4021
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Provider Business Mailing Address
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Address Line | 17017 NORTHERN BLVD
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City | FLUSHING
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State | NY
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Zip | 11358-2709
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Country | US
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Telephone | 718-539-6000
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Fax | 718-539-4021
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Authorized Official
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Title or Position | SECRETARY
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Name | GEORGE CONDAX
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Credential | MD
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Telephone | 718-539-6000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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