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General NPI Number Information
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NPI Number | 1215686670
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Entity Type | Organization
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Legal Business Name | WISE MEDICAL NY PC
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Dates
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Enumeration Date | 03/22/2022
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Last Update Date | 03/22/2022
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Provider Practice Location Address
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Address Line | 14461 38TH AVE
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City | FLUSHING
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State | NY
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Zip | 11354-5935
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Country | US
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Telephone | 212-739-1799
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Fax |
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Provider Business Mailing Address
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Address Line | 5314 16TH AVE STE 405
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City | BROOKLYN
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State | NY
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Zip | 11204-1425
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Country | US
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Telephone | 212-739-1799
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Fax | 212-739-1793
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Authorized Official
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Title or Position | OWNER
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Name | ELI INZLICHT-SPREI
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Credential | MD
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Telephone | 516-535-9181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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