Organization Active NPI

Fort Green Vision Corp

  • Optician
  • Brooklyn, NY
National Provider Identifier
1912320052
Registry record updated Oct 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OpticianTaxonomy code 156FX1800X
License
006307 Issued in NY
Legal business name
FORT GREEN VISION CORP
Practice address
446B Myrtle Ave
Brooklyn, NY 11205-2414
Phone
(718) 246-2020
Fax
(347) 987-4335
NPI assigned
Jan 25, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2023

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

Authorized official

Name
Boris RozhanskyNPI 1326288432
Title
Manager
Phone
(917) 306-5191

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
OpticianGroup: 193400000X SINGLE SPECIALTY GROUP 156FX1800X 006307 NY Primary

Addresses

Primary practice location

446B Myrtle Ave
Brooklyn, NY 11205-2414

Mailing address

446B Myrtle Ave
Brooklyn, NY 11205-2414
Phone (718) 246-2020

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140616001646 NY Part B Supplier - Clinic/Group Practice 0840414736 Receives reassigned benefits from 4 practitioners
Practice locations: Brooklyn, NY

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D2291772Fort Green Vision Inc446 Myrtle Ave, Brooklyn, NY 11205Certificate of waiverMar 26, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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": "1390608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696464000000",
    "number": "1912320052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "446B MYRTLE AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112052414",
            "telephone_number": "718-246-2020",
            "fax_number": "347-987-4335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "446B MYRTLE AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112052414",
            "telephone_number": "718-246-2020",
            "fax_number": "347-987-4335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT GREEN VISION CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-25",
        "last_updated": "2023-10-05",
        "certification_date": "2023-10-05",
        "status": "A",
        "authorized_official_last_name": "ROZHANSKY",
        "authorized_official_first_name": "BORIS",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "917-306-5191"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Technician/Technologist, Optician",
            "state": "NY",
            "license": "006307",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.