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General NPI Number Information
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NPI Number | 1932138112
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Entity Type | Organization
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Legal Business Name | QUEENS OPHTHALMOLOGY PC
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Dates
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Enumeration Date | 07/01/2006
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Last Update Date | 08/31/2010
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Provider Practice Location Address
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Address Line | 5115 BEACH CHANNEL DR
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City | FAR ROCKAWAY
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State | NY
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Zip | 11691-1042
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Country | US
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Telephone | 718-380-8050
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Fax | 718-380-5303
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Provider Business Mailing Address
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Address Line | 440 W BAY DR
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City | LONG BEACH
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State | NY
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Zip | 11561-1838
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Country | US
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Telephone | 718-380-8050
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Fax | 718-380-5303
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Authorized Official
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Title or Position | PRESIDENT
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Name | PANUS ROMSAITONG
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Credential | MD
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Telephone | 718-380-8050
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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 | NY
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