LONG ISLAND VITREO RETINAL CONSULTANTS PC NPI 1235242553

NPI Information

  • NPI: 1235242553
  • Provider Name: LONG ISLAND VITREO RETINAL CONSULTANTS PC
  • Classification: Ophthalmology - 207WX0107X
  • Specialization: Retina Specialist
  • Entity Type: Organization
  • Former Legal Business Name: VITREORETINAL CONSULTANTS PC
  • CLIA Number: 33D1075821
  • Address: 9131 QUEENS BLVD
    SUITE 209
    ELMHURST, NY
    ZIP 11373
  • Phone: (718) 793-6430

Map and Directions

Get Directions

NPI Details

LONG ISLAND VITREO RETINAL CONSULTANTS PC is a retina specialist ophthalmology in Elmhurst, NY. The provider is an ophthalmologist who specializes in the diagnosis and treatment of vitreoretinal diseases. LONG ISLAND VITREO RETINAL CONSULTANTS PC NPI is 1235242553. The provider is registered as an organization entity type and is a single specialty group.
The provider Former Legal Business Name Is Vitreoretinal Consultants Pc.

The provider's business location address is:

9131 QUEENS BLVD
SUITE 209
ELMHURST, NY
ZIP 11373-555
Phone: (718) 793-6430
Fax: (718) 793-6321

The provider's authorized official is David M Fastenberg .
The authorized official title is Authorized Official and has the following contact phone number (516) 466-0390.

The CLIA number assigned to this NPI record is 33D1075821 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/17/2006 and was last updated on 2/13/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207W00000XOphthalmologyNo
2207WX0107XOphthalmologyRetina SpecialistYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
100710554MEDICAIDNEW YORK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

Previous NPI
Next NPI