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Organization
LONG ISLAND VITREO RETINAL CONSULTANTS PC
Active
Organization
LONG ISLAND VITREO RETINAL CONSULTANTS PC
Active
Other names
Vitreoretinal Consultants pc
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH B GRAHAM MD (OWNER)
(516) 466-0390
Entity
Organization
Contact information
Practice address
9131 QUEENS BLVD, SUITE 209, ELMHURST, NY 11373-5555
(718) 793-6430
(718) 793-6321
Mailing address
9131 QUEENS BLVD STE 209, ELMHURST, NY 11373-5511
(718) 793-6430
(718) 793-6321
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
—
—
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00710554
—
NY
Enumeration date
08/17/2006
Last updated
07/23/2026
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