MEDICARE: DR. NORMAN BRET MEDOW M.D.

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	207W00000X	Ophthalmology Physician	099393	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
10	181922385	OTHER	NY	R.R. MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2127300	OTHER	NY	AETNA USHEALTHCARE
2	P2073780	OTHER	NY	OXFORD
3	132760994	OTHER	NY	GUARDIAN PHCS
4	132760994	OTHER	NY	MULTIPLAN
5	132760994	OTHER	NY	EMPIRE BLUE CR/BLUE SH
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	05710P	OTHER	NY	HIP
8	132760994	OTHER	NY	STOREWORKERS
9	132760994	OTHER	NY	NEW YORK HOTEL TRADE

General Provider Information

NPI Number	:	1508864364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NORMAN BRET MEDOW M.D.

Provider Business Mailing Address
First Line	:	111 E 210TH STREET
Second Line	:	MONTEFIORE MEDICAL CENTER DEPARTMENT OF OPHTHALMOLOGY
City	:	BRONX
State	:	NY
Zip	:	10467
Country	:	US
Telephone Number	:	718-920-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	3332 ROCHAMBEAU AVE
Second Line	:	ROOM 306
City	:	BRONX
State	:	NY
Zip	:	10467-2836
Country	:	US
Telephone Number	:	718-920-4609
Fax Number	:	718-881-5439

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	04/25/2012

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