Provider Demographics
NPI:1447677471
Name:MACULA EYE CARE OPHTHALMOLOGY PLLC
Entity type:Organization
Organization Name:MACULA EYE CARE OPHTHALMOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:EVA
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-636-1879
Mailing Address - Street 1:157 W 79TH ST
Mailing Address - Street 2:7 A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-6413
Mailing Address - Country:US
Mailing Address - Phone:212-877-9109
Mailing Address - Fax:
Practice Address - Street 1:67 E 78TH ST
Practice Address - Street 2:1 C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0273
Practice Address - Country:US
Practice Address - Phone:212-744-2513
Practice Address - Fax:212-744-4816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-27
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA072039L207W00000X
NY224954207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1295729762OtherNPI
NYA400003085Medicare PIN
NY431A91Medicare UPIN