MEDICARE: GABRIELLA COHEN FASHION OPTICAL CORP

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	008411	NY

General Provider Information

NPI Number	:	1679869440
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GABRIELLA COHEN FASHION OPTICAL CORP

Provider Business Mailing Address
First Line	:	681 LEXINGTON AVE
Second Line	:	(B/W 56TH AND 57TH STREET)
City	:	NEW YORK
State	:	NY
Zip	:	10022-2625
Country	:	US
Telephone Number	:	212-317-0067
Fax Number	:	212-317-9008

Provider Business Practice Location Address
First Line	:	681 LEXINGTON AVE
Second Line	:	(B/W 56TH AND 57TH STREET)
City	:	NEW YORK
State	:	NY
Zip	:	10022-2625
Country	:	US
Telephone Number	:	212-317-0067
Fax Number	:	212-317-9008

Authorized Official
Title or Position	:	FRANCHISEE
Name	:	LARISA PINKHASOVA
Credential	:
Telephone Number	:	212-697-0915

Provider Enumeration Date	:	06/21/2011
Last Update Date	:	06/21/2011

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Directions to “GABRIELLA COHEN FASHION OPTICAL CORP ” Practice Location

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