1265436091 NPI number — DR. TERRYLEE MAIMONE O.D.

Table of content: DR. TERRYLEE MAIMONE O.D. (NPI 1265436091)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265436091 NPI number — DR. TERRYLEE MAIMONE O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAIMONE
Provider First Name:
TERRYLEE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265436091
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
503 WILLIAMS CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDGEWATER
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07020-1630
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-703-8644
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7000 BOULEVARD EAST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GUTTENBERG
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07093-4818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-854-3489
Provider Business Practice Location Address Fax Number:
201-854-3298
Provider Enumeration Date:
06/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  27OA00490500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152WV0400X , with the licence number: 27TO00040600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: TM23689 . This is a "SPECTERA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 518967 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 223828037 . This is a "PHCS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2319156 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 177820 . This is a "CHN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2K3806 . This is a "HEALTHNET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 6018700 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 223828037 . This is a "MULTI-PLAN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P2865102 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 555558 . This is a "CLARITY VISION" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: C228E1 . This is a "EMPIRE BCBS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2099723 . This is a "FIRST HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 223828037 . This is a "HORIZON" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 4495272 . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 5452503 . This is a "CCN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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