Provider Demographics
NPI:1730180084
Name:BROOKLYN EYE SURGERY CENTER LLC
Entity type:Organization
Organization Name:BROOKLYN EYE SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-645-0600
Mailing Address - Street 1:1301 AVENUE J
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-3605
Mailing Address - Country:US
Mailing Address - Phone:718-645-0600
Mailing Address - Fax:718-692-4456
Practice Address - Street 1:1301 AVENUE J
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-3605
Practice Address - Country:US
Practice Address - Phone:718-645-0600
Practice Address - Fax:718-692-4456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01621232Medicaid
NY01621232Medicaid