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Organization

LONG ISLAND VITREO RETINAL CONSULTANTS PC

Active
Other names
Vitreoretinal Consultants pc
Organization subpart
No

Provider details

NPI number
Authorized official
DAVID M FASTENBERG MD (AUTHORIZED OFFICIAL)
(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, SUITE 209, ELMHURST, NY 11373-5555
(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
02/13/2019
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