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General NPI Number Information
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NPI Number | 1326571993
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Entity Type | Organization
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Legal Business Name | CHILDREN'S OPHTHALMOLOGY, P.C.
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Dates
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Enumeration Date | 04/10/2017
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Last Update Date | 01/08/2024
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Provider Practice Location Address
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Address Line | 40 SAW MILL RIVER RD
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City | HAWTHORNE
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State | NY
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Zip | 10532-1535
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Country | US
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Telephone | 617-355-6401
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Fax | 617-730-0392
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Provider Business Mailing Address
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Address Line | 300 LONGWOOD AVE FEGAN 4
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City | BOSTON
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State | MA
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Zip | 02115-5724
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Country | US
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Telephone | 617-355-6401
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Fax | 617-730-0392
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Authorized Official
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Title or Position | PROGRAM MANAGER
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Name | JESSICA COULEHAN
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Credential |
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Telephone | 914-909-4700
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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 |
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License Number State |
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