1356712533 NPI number — DYD VISION AND HEARING CORP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356712533 NPI number — DYD VISION AND HEARING CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DYD VISION AND HEARING CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DAHLIA'S VISION AND HEARING
Provider Other Organization Name Type Code:
3
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:
1356712533
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
225 N WOOD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINDEN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07036-4200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
397 HALEDON AVE # 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HALEDON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07508-1551
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-472-9361
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/13/2015

Additional Information

Authorized Official

Authorized Official Last Name:
AYLAROFF
Authorized Official First Name:
ARTHUR
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
908-583-5284

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0593842 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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