MEDICARE: LENS LAND OF ASTORIA

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	156F00000X	Technician/Technologist

General Provider Information

NPI Number	:	1750433942
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LENS LAND OF ASTORIA

Provider Business Mailing Address
First Line	:	1955 TURNBULL AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10473-2516
Country	:	US
Telephone Number	:	718-278-8780
Fax Number	:	718-626-5405

Provider Business Practice Location Address
First Line	:	1955 TURNBULL AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10473-2516
Country	:	US
Telephone Number	:	718-278-8780
Fax Number	:	718-626-5405

Authorized Official
Title or Position	:	MANAGER
Name	:	SHERI LYNN SMITH
Credential	:
Telephone Number	:	718-626-5184

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	03/21/2019

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Directions to “LENS LAND OF ASTORIA ” Practice Location

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