| |
4526 Broadway, New York, NY 10040-2404 | |
(212) 304-3585 | |
Not Available |
Full Name | |
---|---|
Type | Facility |
Speciality | Technician/technologist - Optician |
Location | 4526 Broadway, New York, New York |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1528116282 | NPI | - | NPPES |
02826259 | Medicaid | NY |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | TUV 006977 (New York) | Primary |
156FX1800X | Technician/technologist - Optician | 007305-1 (New York) | Primary |
Provider Name | Yelena Kagan |
---|---|
Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1427287440 PECOS PAC ID: 1759436322 Enrollment ID: I20090903000097 |
Provider Name | Yung Han Chen |
---|---|
Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1629333034 PECOS PAC ID: 5496901076 Enrollment ID: I20150417000205 |
Mailing Address | Practice Location Address |
---|---|
4526 Broadway, New York, NY 10040-2404 Ph: (212) 304-3585 | 4526 Broadway, New York, NY 10040-2404 Ph: (212) 304-3585 |