MEDICARE: CFO RETAIL OF NEW YORK, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1306197181
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CFO RETAIL OF NEW YORK, LLC

Provider Business Mailing Address
First Line	:	520 8TH AVE
Second Line	:	SUITE 901
City	:	NEW YORK
State	:	NY
Zip	:	10018-6507
Country	:	US
Telephone Number	:	212-729-5373
Fax Number	:	212-967-5927

Provider Business Practice Location Address
First Line	:	603 6TH AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10011-2042
Country	:	US
Telephone Number	:	212-924-1390
Fax Number	:	212-924-1395

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	DARLEEN CETTINA
Credential	:
Telephone Number	:	212-729-5373

Provider Enumeration Date	:	09/20/2012
Last Update Date	:	08/01/2016

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