Provider Demographics
NPI:1114223377
Name:CHEAPER PEEPERS OF NEW YORK MDIV, INC.
Entity type:Organization
Organization Name:CHEAPER PEEPERS OF NEW YORK MDIV, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGED CARE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANSUY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-719-7554
Mailing Address - Street 1:203 NEWBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HITCKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-3933
Mailing Address - Country:US
Mailing Address - Phone:248-719-7554
Mailing Address - Fax:248-719-7564
Practice Address - Street 1:5150 COOLIDGE HWY
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-1001
Practice Address - Country:US
Practice Address - Phone:248-435-4200
Practice Address - Fax:248-288-2124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-07
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332G00000XSuppliersEye BankGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
900F395210OtherBCBSM