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Organization
LONG ISLAND VITREO RETINAL CONSULTANTS
Active
Organization
LONG ISLAND VITREO RETINAL CONSULTANTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM MACCARONE (CREDENTIALING MANAGER)
(516) 466-0390
Entity
Organization
Contact information
Practice address
600 NORTHERN BLVD STE 216, GREAT NECK, NY 11021-5200
(516) 466-0390
(516) 466-4956
Mailing address
600 NORTHERN BLVD STE 216, GREAT NECK, NY 11021-5200
(516) 466-0390
(516) 466-4956
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
—
—
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
316B51
DR V DERAMO
NY
01
—
423B91
DR K GRAHAM
NY
01
—
44I491
DR E SHAKIN
NY
01
—
45A371
DR J SHAKIN
NY
01
—
467A61
DR B ROSENBLATT
NY
01
—
5T9101
DR P FERRONE
NY
01
—
71A461
DR D FASTENBERG
NY
Enumeration date
09/05/2007
Last updated
01/15/2019
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