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General NPI Number Information
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NPI Number | 1942412572
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Entity Type | Organization
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Legal Business Name | MANHATTAN OCULOFACIAL PLASTIC SURGERY, PC
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 07/23/2018
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Provider Practice Location Address
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Address Line | 1036 PARK AVE # 1C
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City | NEW YORK
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State | NY
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Zip | 10028
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Country | US
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Telephone | 212-717-2150
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Fax |
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Provider Business Mailing Address
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Address Line | 475 E 72ND ST SUITE#101
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City | NEW YORK
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State | NY
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Zip | 10021-4458
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Country | US
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Telephone | 212-717-2150
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BOAZ JACOB LISSAUER
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Credential | MD
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Telephone | 212-717-2150
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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 | 208452
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License Number State | NY
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