=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386763043
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADRIAN I. EPSTEIN,OD,PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2007
-----------------------------------------------------
Last Update Date | 05/06/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 42 PLYMOUTH AVE
-----------------------------------------------------
City | MOUNT SINAI
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11766-2528
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-928-7575
-----------------------------------------------------
Fax | 631-928-6277
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 42 PLYMOUTH AVE
-----------------------------------------------------
City | MOUNT SINAI
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11766-2528
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-928-7575
-----------------------------------------------------
Fax | 631-928-6277
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ADRIAN IRA EPSTEIN
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 631-928-7575
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | T003255
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------