NPIMap

Organization Active NPI

Long Island Vitreo Retinal Consultants

  • Retina Specialist (Ophthalmology) Physician
  • Great Neck, NY
National Provider Identifier
1740474402
Registry record updated Jan 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Retina Specialist (Ophthalmology) PhysicianTaxonomy code 207WX0107X
Legal business name
LONG ISLAND VITREO RETINAL CONSULTANTS
Practice address
600 Northern Blvd Ste 216
Great Neck, NY 11021-5200
Phone
(516) 466-0390
Fax
(516) 466-4956
NPI assigned
Sep 5, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2019

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

Authorized official

Name
Kim Maccarone
Title
Credentialing Manager
Phone
(516) 466-0390

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

600 Northern Blvd Ste 216
Great Neck, NY 11021-5200

Mailing address

600 Northern Blvd Ste 216
Great Neck, NY 11021-5200
Phone (516) 466-0390

Other practice location 1

200 Motor Pkwy Ste A2
Hauppauge, NY 11788-5112
Phone (631) 234-5666

Other practice location 2

64 N Long Beach Rd
Rockville Centre, NY 11570-5030
Phone (516) 594-1010

Other practice location 3

47 Commerce Ave Ste 2
Riverhead, NY 11901-3106
Phone (631) 905-0666

Other practice location 4

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

Other practice location 5

13625 Maple Ave Ste 202
Flushing, NY 11355-3891
Phone (516) 466-0390

Other identifiers 7

IdentifierTypeStateIssuer
44I491OtherNYDR E SHAKIN
423B91OtherNYDR K GRAHAM
5T9101OtherNYDR P FERRONE
45A371OtherNYDR J SHAKIN
316B51OtherNYDR V DERAMO
467A61OtherNYDR B ROSENBLATT
71A461OtherNYDR D FASTENBERG

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

600 Northern Blvd
Ste 216
Great Neck, NY 11021
Phone 5164660390204

Practitioners & affiliated clinicians

Practitioners 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1188950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1547510400000",
    "number": "1740474402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 NORTHERN BLVD STE 216",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110215200",
            "telephone_number": "516-466-0390",
            "fax_number": "516-466-4956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 NORTHERN BLVD STE 216",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110215200",
            "telephone_number": "516-466-0390",
            "fax_number": "516-466-4956"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 Motor Pkwy Ste A2",
            "address_purpose": "LOCATION",
            "city": "Hauppauge",
            "state": "NY",
            "postal_code": "117885112",
            "country_code": "US",
            "telephone_number": "631-234-5666",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "64 N Long Beach Rd",
            "address_purpose": "LOCATION",
            "city": "Rockville Centre",
            "state": "NY",
            "postal_code": "115705030",
            "country_code": "US",
            "telephone_number": "516-594-1010",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "47 Commerce Ave Ste 2",
            "address_purpose": "LOCATION",
            "city": "Riverhead",
            "state": "NY",
            "postal_code": "119013106",
            "country_code": "US",
            "telephone_number": "631-905-0666",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9131 Queens Blvd Ste 209",
            "address_purpose": "LOCATION",
            "city": "Elmhurst",
            "state": "NY",
            "postal_code": "113735511",
            "country_code": "US",
            "telephone_number": "718-793-6430",
            "fax_number": "718-793-6321",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "13625 Maple Ave Ste 202",
            "address_purpose": "LOCATION",
            "city": "Flushing",
            "state": "NY",
            "postal_code": "113553891",
            "country_code": "US",
            "telephone_number": "516-466-0390",
            "fax_number": "516-829-0520",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LONG ISLAND VITREO RETINAL CONSULTANTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-05",
        "last_updated": "2019-01-15",
        "status": "A",
        "authorized_official_last_name": "MACCARONE",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "516-466-0390"
    },
    "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": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DR E SHAKIN",
            "identifier": "44I491",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DR K GRAHAM",
            "identifier": "423B91",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DR P FERRONE",
            "identifier": "5T9101",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DR J SHAKIN",
            "identifier": "45A371",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DR V DERAMO",
            "identifier": "316B51",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DR B ROSENBLATT",
            "identifier": "467A61",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DR D FASTENBERG",
            "identifier": "71A461",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Great Neck, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2019; 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.