Provider Demographics
NPI:1861438707
Name:JG VISION ASSOCIATES,INC
Entity type:Organization
Organization Name:JG VISION ASSOCIATES,INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:GIAMBALVO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-654-2020
Mailing Address - Street 1:702 ALLERTON AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-8218
Mailing Address - Country:US
Mailing Address - Phone:718-654-2020
Mailing Address - Fax:718-654-2325
Practice Address - Street 1:702 ALLERTON AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-8218
Practice Address - Country:US
Practice Address - Phone:718-654-2020
Practice Address - Fax:718-654-2325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004106156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02653689Medicaid
NY02653689Medicaid
5298150001Medicare NSC