MEDICARE: SPECS FOR LESS OF THIRD AVE

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	156FX1800X	Optician	4792	NY

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	:	1528043734
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECS FOR LESS OF THIRD AVE

Provider Business Mailing Address
First Line	:	1904 3RD AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10029-4601
Country	:	US
Telephone Number	:	212-831-3162
Fax Number	:

Provider Business Practice Location Address
First Line	:	1904 3RD AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10029-4601
Country	:	US
Telephone Number	:	212-831-3162
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JEFFREY L. KIRSCH
Credential	:
Telephone Number	:	212-831-3162

Provider Enumeration Date	:	12/09/2005
Last Update Date	:	08/22/2020

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Directions to “SPECS FOR LESS OF THIRD AVE ” Practice Location

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