Basic Information
| Provider Information | |||||||||
| NPI: | 1508864364 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MEDOW | ||||||||
| FirstName: | NORMAN | ||||||||
| MiddleName: | BRET | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 E 210TH STREET | ||||||||
| Address2: | MONTEFIORE MEDICAL CENTER DEPARTMENT OF OPHTHALMOLOGY | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10467 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189202020 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3332 ROCHAMBEAU AVE | ||||||||
| Address2: | ROOM 306 | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104672836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189204609 | ||||||||
| FaxNumber: | 7188815439 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2005 | ||||||||
| LastUpdateDate: | 04/25/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 099393 | NY | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 2127300 | 01 | NY | AETNA USHEALTHCARE | OTHER | P2073780 | 01 | NY | OXFORD | OTHER | 132760994 | 01 | NY | GUARDIAN PHCS | OTHER | 132760994 | 01 | NY | MULTIPLAN | OTHER | 132760994 | 01 | NY | EMPIRE BLUE CR/BLUE SH | OTHER | 00169791 | 05 | NY | MEDICAID | 05710P | 01 | NY | HIP | OTHER | 132760994 | 01 | NY | STOREWORKERS | OTHER | 132760994 | 01 | NY | NEW YORK HOTEL TRADE | OTHER | 181922385 | 01 | NY | R.R. MEDICARE | OTHER |