Provider Demographics
NPI:1306022652
Name:BAY RIDGE EYE & RETINA SPECIALIST
Entity type:Organization
Organization Name:BAY RIDGE EYE & RETINA SPECIALIST
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMER
Authorized Official - Middle Name:A
Authorized Official - Last Name:KHOSROF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-733-5780
Mailing Address - Street 1:333 86TH ST
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-5057
Mailing Address - Country:US
Mailing Address - Phone:718-630-1010
Mailing Address - Fax:718-630-1020
Practice Address - Street 1:333 86TH ST
Practice Address - Street 2:SUITE 1B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-5057
Practice Address - Country:US
Practice Address - Phone:718-630-1010
Practice Address - Fax:718-630-1020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241115207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty