Provider Demographics
NPI:1679869440
Name:GABRIELLA COHEN FASHION OPTICAL CORP
Entity type:Organization
Organization Name:GABRIELLA COHEN FASHION OPTICAL CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FRANCHISEE
Authorized Official - Prefix:
Authorized Official - First Name:LARISA
Authorized Official - Middle Name:
Authorized Official - Last Name:PINKHASOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-697-0915
Mailing Address - Street 1:681 LEXINGTON AVE
Mailing Address - Street 2:(B/W 56TH AND 57TH STREET)
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2625
Mailing Address - Country:US
Mailing Address - Phone:212-317-0067
Mailing Address - Fax:212-317-9008
Practice Address - Street 1:681 LEXINGTON AVE
Practice Address - Street 2:(B/W 56TH AND 57TH STREET)
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2625
Practice Address - Country:US
Practice Address - Phone:212-317-0067
Practice Address - Fax:212-317-9008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008411332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier