Provider Demographics
NPI:1447501036
Name:NASSAU COUNTY OPHTHALMOLOGY PC
Entity type:Organization
Organization Name:NASSAU COUNTY OPHTHALMOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SAFFRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-239-6789
Mailing Address - Street 1:22 BAYBERRY RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-2705
Mailing Address - Country:US
Mailing Address - Phone:516-239-6789
Mailing Address - Fax:516-239-5023
Practice Address - Street 1:1229 BROADWAY
Practice Address - Street 2:STE 210
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557-2014
Practice Address - Country:US
Practice Address - Phone:516-239-6789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-24
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY179379207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty