Individual
MARTIN ALEX MUNDACKAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
4204 BROADWAY, NEW YORK, NY 10033-3706
(917) 920-2636
Mailing address
212 BENEDICT AVE, THORNWOOD, NY 10594-1204
(212) 433-0136
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
011180
NY
Other
Enumeration date
06/30/2025
Last updated
07/07/2025
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