Provider Demographics
NPI:1730380932
Name:ORANGETOWN OPHTHALMOLOGY NY PC
Entity type:Organization
Organization Name:ORANGETOWN OPHTHALMOLOGY NY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBALL
Authorized Official - Middle Name:PRATT
Authorized Official - Last Name:WOODWARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-348-3400
Mailing Address - Street 1:2 CROSFIELD AVE
Mailing Address - Street 2:STE 315
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-2220
Mailing Address - Country:US
Mailing Address - Phone:845-348-3400
Mailing Address - Fax:348-348-3438
Practice Address - Street 1:2 CROSFIELD AVE
Practice Address - Street 2:STE 315
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-2220
Practice Address - Country:US
Practice Address - Phone:845-348-3400
Practice Address - Fax:348-348-3438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY167622207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0402468OtherGHI
NYWEL741Medicare PIN