Basic Information
| Provider Information | |||||||||
| NPI: | 1245660075 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHEAST EYE SURGEONS PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 920 REVOLUTION ST | ||||||||
| Address2: | |||||||||
| City: | HAVRE DE GRACE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210783748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8558762020 | ||||||||
| FaxNumber: | 3027341921 | ||||||||
| Practice Location | |||||||||
| Address1: | 920 REVOLUTION ST | ||||||||
| Address2: | |||||||||
| City: | HAVRE DE GRACE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210783748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8558762020 | ||||||||
| FaxNumber: | 3027341921 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2013 | ||||||||
| LastUpdateDate: | 11/20/2013 | ||||||||
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| AuthorizedOfficialLastName: | YEROUSHALMI | ||||||||
| AuthorizedOfficialFirstName: | ALLEN | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | M. D/PART OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8558762020 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M. D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | D76762 | MD | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.