Provider Demographics
NPI:1033712567
Name:OPHTHALMOLOGY SPECIALIST OF QUEENS PLLC
Entity type:Organization
Organization Name:OPHTHALMOLOGY SPECIALIST OF QUEENS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HORTA-SANTINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-832-7557
Mailing Address - Street 1:10005 ROOSEVELT AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-4880
Mailing Address - Country:US
Mailing Address - Phone:917-832-7557
Mailing Address - Fax:919-832-7503
Practice Address - Street 1:10005 ROOSEVELT AVE STE 202
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-4880
Practice Address - Country:US
Practice Address - Phone:917-832-7557
Practice Address - Fax:919-832-7503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery