1598968075 NPI number — MATTHEW J MARANO JR MD

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 1598968075 NPI number — MATTHEW J MARANO JR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MATTHEW J MARANO JR MD
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:
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:
1598968075
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7198
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEDMINSTER
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07921-7198
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-467-1810
Provider Business Mailing Address Fax Number:
973-467-4225

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
556 EAGLE ROCK AVE
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
ROSELAND
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07068-1503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-468-1810
Provider Business Practice Location Address Fax Number:
973-467-1873
Provider Enumeration Date:
06/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MARANO JR
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OPHTHALMOLOGIST
Authorized Official Telephone Number:
973-467-1810

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  25MA04054400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1388509 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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