Provider Demographics
NPI:1801056619
Name:STEVEN A. ODRICH,MD, MARC G. ODRICH, MD, PC
Entity type:Organization
Organization Name:STEVEN A. ODRICH,MD, MARC G. ODRICH, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FLORENCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HATTASCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-432-2020
Mailing Address - Street 1:3765 RIVERDALE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1845
Mailing Address - Country:US
Mailing Address - Phone:718-432-2020
Mailing Address - Fax:718-432-8482
Practice Address - Street 1:3765 RIVERDALE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1845
Practice Address - Country:US
Practice Address - Phone:718-432-2020
Practice Address - Fax:718-432-8482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY163491207W00000X
NY179385207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000B21OtherBLUE CROSS
NY7934148OtherCIGNA
NYP452672OtherOXFORD
NY01783462Medicaid
NY01444600Medicaid
NY1120632OtherUNITED HEALTHCARE
NY0052450OtherGHI
NYGS278OtherOXFORD
NYF40502Medicare UPIN
NYGS278OtherOXFORD
NY01444600Medicaid