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General NPI Number Information
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NPI Number | 1689608754
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Entity Type | Organization
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Legal Business Name | QUEENS EYECARE PHYSICIAN PC
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 01/10/2008
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Provider Practice Location Address
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Address Line | 200 20 44TH AVENUE
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City | BAYSIDE
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State | NY
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Zip | 11361-2537
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Country | US
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Telephone | 718-281-4500
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Fax | 718-631-4901
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Provider Business Mailing Address
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Address Line | 200 20 44TH AVENUE
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City | BAYSIDE
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State | NY
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Zip | 11361-2537
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Country | US
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Telephone | 718-281-4500
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Fax | 718-631-4901
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Authorized Official
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Title or Position | OWNER
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Name | LESLIE ALAN SHAPIRO
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Credential | MD
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Telephone | 718-281-4500
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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 | 112689
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License Number State | NY
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