Organization
LONG ISLAND VITREO RETINAL CONSULTANTS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM I MACCARONE (CREDENTIALING MANAGER)
(516) 466-0390
Entity
Organization
Contact information
Practice address
600 NORTHERN BLVD, SUITE 216, GREAT NECK, NY 11021
(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
05
—
00710554
—
NY
Enumeration date
08/17/2006
Last updated
04/08/2026
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