=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265645212
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MANHASSET EYE PHYSICIANS, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2007
-----------------------------------------------------
Last Update Date | 03/24/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1615 NORTHERN BLVD SUITE 202
-----------------------------------------------------
City | MANHASSET
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11030-3033
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-627-0146
-----------------------------------------------------
Fax | 516-365-4750
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1615 NORTHERN BLVD SUITE 202
-----------------------------------------------------
City | MANHASSET
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11030-3033
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-627-0146
-----------------------------------------------------
Fax | 516-365-4750
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. PETER ANTHONY D'ARIENZO
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 516-627-0146
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 180111
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 097435
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 187507
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------