MEDICARE: RIVERDALE OPHTHALMOLOGY, PLLC

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1871298240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERDALE OPHTHALMOLOGY, PLLC

Provider Business Mailing Address
First Line	:	3220 FAIRFIELD AVE STE C1
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10463-3240
Country	:	US
Telephone Number	:	718-432-2000
Fax Number	:	718-432-2001

Provider Business Practice Location Address
First Line	:	475 TUCKAHOE RD STE 203
Second Line	:
City	:	YONKERS
State	:	NY
Zip	:	10710-5716
Country	:	US
Telephone Number	:	914-961-2700
Fax Number	:	914-961-0369

Authorized Official
Title or Position	:	PHYSICIAN/ OWNER
Name	:	DR. TOD MATHEW HALLER
Credential	:	MD
Telephone Number	:	718-432-2000

Provider Enumeration Date	:	04/04/2023
Last Update Date	:	04/04/2023

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