Doctor Name: | DIANE MASTROLY |
NPI Number: | 1417022906 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 3395 |
Business Practice Address: | 1933 State Route 35 Suite 120 Wall Township, NJ - 077193502 |
Business Phone Number: | 7324499503 |
Business Fax Number: | |
Mailing Address: | 1933 Rt.35, Suite 120 WALL |
State: | NJ |
Postal Code: | 07719 |
Phone Number: | 7324499503 |
Fax Number: | |
NPI Enumeration Date: | 11/21/2006 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 156FX1800X |
License Number: | 3395 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Eye and Vision Services Providers |
Taxonomy Classification: | Technician/Technologist |
Taxonomy Specialization: | Optician |
Taxonomy Definition: |