Provider Demographics
NPI:1972695807
Name:GINBERG, KATERINA (OD)
Entity type:Individual
Prefix:
First Name:KATERINA
Middle Name:
Last Name:GINBERG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 FAWNS RUN
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-4403
Mailing Address - Country:US
Mailing Address - Phone:917-945-5636
Mailing Address - Fax:
Practice Address - Street 1:12073 FLATLANDS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-8306
Practice Address - Country:US
Practice Address - Phone:718-257-7700
Practice Address - Fax:718-257-7704
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006809152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02642024Medicaid
NYC377D1Medicare ID - Type Unspecified
NY5928210001Medicare NSC
NY02642024Medicaid