NPIMap

Organization Active NPI

Long Island Vitreo Retinal Consultants PC

  • Retina Specialist (Ophthalmology) Physician
  • Elmhurst, NY
National Provider Identifier
1235242553
Registry record updated Jul 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Retina Specialist (Ophthalmology) PhysicianTaxonomy code 207WX0107X
Legal business name
LONG ISLAND VITREO RETINAL CONSULTANTS PC
Practice address
9131 Queens Blvd
Suite 209
Elmhurst, NY 11373-5555
Phone
(718) 793-6430
Fax
(718) 793-6321
NPI assigned
Aug 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kenneth B Graham, MDNPI 1457464778
Title
Owner
Phone
(516) 466-0390

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X
Retina Specialist (Ophthalmology) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207WX0107X Primary

Addresses

Primary practice location

9131 Queens Blvd
Suite 209
Elmhurst, NY 11373-5555

Mailing address

9131 Queens Blvd Ste 209
Elmhurst, NY 11373-5511
Phone (718) 793-6430

Other identifiers 1

IdentifierTypeStateIssuer
00710554MedicaidNY

Other names 1

  • Vitreoretinal Consultants pc Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Long Island Vitreo Retinal Consultants4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

9131 Queens Blvd
Ste 209
Elmhurst, NY 11373
Phone (718) 793-6430

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 16

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1784764800000",
    "number": "1235242553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9131 QUEENS BLVD STE 209",
            "city": "ELMHURST",
            "state": "NY",
            "postal_code": "113735511",
            "telephone_number": "718-793-6430",
            "fax_number": "718-793-6321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9131 QUEENS BLVD",
            "address_2": "SUITE 209",
            "city": "ELMHURST",
            "state": "NY",
            "postal_code": "113735555",
            "telephone_number": "718-793-6430",
            "fax_number": "718-793-6321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONG ISLAND VITREO RETINAL CONSULTANTS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-17",
        "last_updated": "2026-07-23",
        "certification_date": "2026-07-23",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "516-466-0390",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207WX0107X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology, Retina Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00710554",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vitreoretinal Consultants pc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Elmhurst, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.