Organization Active NPI

Schenectady Eye Surgery Associates, PLLC

  • Ophthalmology Physician
  • Schenectady, NY
National Provider Identifier
1770922130
Registry record updated Jun 25, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
SCHENECTADY EYE SURGERY ASSOCIATES, PLLC
Practice address
1201 Nott St
Ste. 105
Schenectady, NY 12308-2589
Phone
(518) 374-0483
Fax
(518) 374-0515
NPI assigned
Jun 19, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2014

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

Authorized official

Name
Ms. Darlene Fuller, B.A.
Title
Office Manager
Phone
(518) 374-0483

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

1201 Nott St
Ste. 105
Schenectady, NY 12308-2589

Mailing address

1201 Nott St Ste 105
Schenectady, NY 12308-2589
Phone (518) 374-0483

Other identifiers 1

IdentifierTypeStateIssuer
1705OtherNYCDPHP

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140623001019 NY Part B Supplier - Clinic/Group Practice 9638393218 Receives reassigned benefits from 2 practitioners
Practice locations: Schenectady, NY

National Provider Directory

National Provider Directory
Tax ID family
Franklin B Longo MD2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

1201 Nott St
Ste 105
Schenectady, NY 12308
Phone (518) 374-0483

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1371600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403654400000",
    "number": "1770922130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 NOTT ST STE 105",
            "city": "SCHENECTADY",
            "state": "NY",
            "postal_code": "123082589",
            "telephone_number": "518-374-0483",
            "fax_number": "518-374-0515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 NOTT ST",
            "address_2": "STE. 105",
            "city": "SCHENECTADY",
            "state": "NY",
            "postal_code": "123082589",
            "telephone_number": "518-374-0483",
            "fax_number": "518-374-0515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SCHENECTADY EYE SURGERY ASSOCIATES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-19",
        "last_updated": "2014-06-25",
        "status": "A",
        "authorized_official_last_name": "FULLER",
        "authorized_official_first_name": "DARLENE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "518-374-0483",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "B.A."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CDPHP",
            "identifier": "1705",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Schenectady, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.