Provider Demographics
NPI:1750350104
Name:NEURO-OPHTHALMIC ASSOCIATES
Entity type:Organization
Organization Name:NEURO-OPHTHALMIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MYLES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BEHRENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-305-5415
Mailing Address - Street 1:635 WEST 165 ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11753
Mailing Address - Country:US
Mailing Address - Phone:212-305-5415
Mailing Address - Fax:212-305-3389
Practice Address - Street 1:635 WEST 165 ST
Practice Address - Street 2:
Practice Address - City:NEW YORK CITY
Practice Address - State:NY
Practice Address - Zip Code:11753
Practice Address - Country:US
Practice Address - Phone:212-305-5415
Practice Address - Fax:212-305-3389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY90955207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B79644Medicare UPIN