Provider Demographics
NPI:1891725081
Name:GLAUCOMA PRACTICE OF NEW YORK, PLLC
Entity type:Organization
Organization Name:GLAUCOMA PRACTICE OF NEW YORK, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAI
Authorized Official - Middle Name:BHUJANGARAO
Authorized Official - Last Name:GANDHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-533-6565
Mailing Address - Street 1:PO BOX 358
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-0358
Mailing Address - Country:US
Mailing Address - Phone:518-533-6565
Mailing Address - Fax:518-533-6567
Practice Address - Street 1:1220 NEW SCOTLAND RD
Practice Address - Street 2:SUITE 303
Practice Address - City:SLINGERLANDS
Practice Address - State:NY
Practice Address - Zip Code:12159-9386
Practice Address - Country:US
Practice Address - Phone:518-533-6565
Practice Address - Fax:518-533-6567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDF0279OtherRAILROAD MEDICARE
NYDF0279OtherRAILROAD MEDICARE