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General NPI Number Information
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NPI Number | 1336435429
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Entity Type | Organization
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Legal Business Name | SMOLYAK GLUACOMA CONSULTANT PC
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Dates
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Enumeration Date | 06/27/2011
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Last Update Date | 06/27/2011
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Provider Practice Location Address
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Address Line | 128 MOTT ST
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City | NEW YORK
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State | NY
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Zip | 10013-5540
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Country | US
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Telephone | 718-646-2200
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Fax | 718-646-6623
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Provider Business Mailing Address
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Address Line | 7109 19TH AVE
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City | BROOKLYN
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State | NY
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Zip | 11204-5316
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Country | US
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Telephone | 718-646-2200
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Fax | 718-646-6623
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. REGINA SMOLYAK
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Credential |
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Telephone | 718-646-2200
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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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