Organization
LONG ISLAND VITREO RETINAL CONSULTANTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANNMARIE GAMBA (BILLING MANAGER)
(516) 466-0390
Entity
Organization
Contact information
Practice address
47 COMMERCE DR, SUITE 2, RIVERHEAD, NY 11901-3106
(631) 905-0666
(516) 905-0660
Mailing address
47 COMMERCE DR, SUITE 2, RIVERHEAD, NY 11901-3106
(631) 905-0666
(516) 905-0660
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
316B51
DR V DERAMO
NY
01
—
423B91
DR K GRAHAM
NY
01
—
43F372
DR B GOLUB
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 FASTENBERG
NY
Enumeration date
09/06/2007
Last updated
09/18/2007
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