Provider Demographics
NPI:1730169780
Name:GLAUCOMA ASSOCIATES OF NEW YORK PC
Entity type:Organization
Organization Name:GLAUCOMA ASSOCIATES OF NEW YORK PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:ILITCHEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-477-7540
Mailing Address - Street 1:310 E 14TH ST
Mailing Address - Street 2:SUITE 304 S
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4201
Mailing Address - Country:US
Mailing Address - Phone:212-477-7540
Mailing Address - Fax:212-388-1517
Practice Address - Street 1:310 E 14TH ST
Practice Address - Street 2:SUITE 304 S
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4201
Practice Address - Country:US
Practice Address - Phone:212-477-7540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-17
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty