Provider Demographics
NPI:1104491844
Name:MA OPHTHALMOLOGY, PLLC
Entity type:Organization
Organization Name:MA OPHTHALMOLOGY, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAIYIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-667-2655
Mailing Address - Street 1:69 EAKINS RD
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-2632
Mailing Address - Country:US
Mailing Address - Phone:917-667-2655
Mailing Address - Fax:
Practice Address - Street 1:3616 MAIN ST FL 9
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4105
Practice Address - Country:US
Practice Address - Phone:917-667-2655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MA OPHTHALMOLOGY, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-05-25
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05763199Medicaid