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General NPI Number Information
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NPI Number | 1720156458
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Entity Type | Organization
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Legal Business Name | OPHTHALMIC CONSULTANTS OF LONG ISLAND
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3742 73RD ST
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372-6246
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Country | US
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Telephone | 718-426-3736
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Fax | 718-426-4474
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Provider Business Mailing Address
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Address Line | 266 MERRICK RD SUITE 110
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City | LYNBROOK
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State | NY
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Zip | 11563-2640
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Country | US
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Telephone | 516-872-8309
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Fax | 516-872-2182
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Authorized Official
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Title or Position | CEO
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Name | THOMAS BURKE
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Credential |
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Telephone | 516-872-8309
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 193409
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License Number State | NY
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