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General NPI Number Information
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NPI Number | 1275085573
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Entity Type | Organization
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Legal Business Name | VILLAGE OPHTHALMOLOGY PC
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Dates
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Enumeration Date | 11/03/2016
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Last Update Date | 11/03/2016
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Provider Practice Location Address
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Address Line | 11 5TH AVE STE B
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City | NEW YORK
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State | NY
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Zip | 10003-4342
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Country | US
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Telephone | 212-777-1644
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Fax | 212-260-1158
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Provider Business Mailing Address
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Address Line | 11 5TH AVE STE B
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City | NEW YORK
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State | NY
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Zip | 10003-4342
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Country | US
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Telephone | 212-777-1644
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Fax | 212-260-1158
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Authorized Official
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Title or Position | OPHTHALMOLOGIST
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Name | DR. LEEBER COHEN
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Credential | MD
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Telephone | 212-777-1644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 162015
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License Number State | NY
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