Provider Demographics
NPI:1114721396
Name:RETINA SPECIALISTS OF NEW YORK, PLLC
Entity type:Organization
Organization Name:RETINA SPECIALISTS OF NEW YORK, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:CONDAX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-539-6000
Mailing Address - Street 1:17017 NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-2709
Mailing Address - Country:US
Mailing Address - Phone:718-539-6000
Mailing Address - Fax:718-539-4021
Practice Address - Street 1:17017 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-2709
Practice Address - Country:US
Practice Address - Phone:718-539-6000
Practice Address - Fax:718-539-4021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-04
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Multi-Specialty