1194772566 NPI number — GILIBERTI EYE AND LASER CENTER P C

Table of content: MR. VICTOR MANUEL VALENCIA JR. (NPI 1245738376)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194772566 NPI number — GILIBERTI EYE AND LASER CENTER P C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GILIBERTI EYE AND LASER CENTER P C
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:
1194772566
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
415 TOTOWA ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOTOWA
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07512
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-595-0011
Provider Business Mailing Address Fax Number:
973-595-5155

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
415 TOTOWA ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOTOWA
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-595-0011
Provider Business Practice Location Address Fax Number:
973-595-5155
Provider Enumeration Date:
05/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GILIBERTI
Authorized Official First Name:
ORAZIO
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
973-595-0011

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  25MA04637500 , 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)





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