MEDICARE: MEDICAL AND SURGICAL EYESITE PC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518948934
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL AND SURGICAL EYESITE PC

Provider Business Mailing Address
First Line	:	22 BAYBERRY RD
Second Line	:
City	:	LAWRENCE
State	:	NY
Zip	:	11559-2705
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	902 49TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-2922
Country	:	US
Telephone Number	:	718-283-7999
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. NORMAN SAFFRA
Credential	:	MD
Telephone Number	:	718-283-7999

Provider Enumeration Date	:	11/11/2005
Last Update Date	:	08/22/2020

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