| |
1107 Valley Rd, Suite 3, Stirling, NJ 07980-1524 | |
(908) 580-2555 | |
(908) 580-2544 |
Full Name | |
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Type | Facility |
Speciality | Optometrist |
Location | 1107 Valley Rd, Stirling, New Jersey |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
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1649391764 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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152W00000X | Optometrist | 27OA00542600 (New Jersey) | Primary |
Provider Name | John Ippolito |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1447292586 PECOS PAC ID: 1456389741 Enrollment ID: I20050728000428 |
Provider Name | Lillian Fasman |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1780066506 PECOS PAC ID: 1254646110 Enrollment ID: I20150820012191 |
Mailing Address | Practice Location Address |
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1107 Valley Rd, Suite 3, Stirling, NJ 07980-1524 Ph: (908) 580-2555 | 1107 Valley Rd, Suite 3, Stirling, NJ 07980-1524 Ph: (908) 580-2555 |
Dr. John Mario Ippolito, OD Optometrist Medicare: Accepting Medicare Assignments Practice Location: 1107 Valley Rd, Suite 3, Stirling, NJ 07980 Phone: 908-580-2555 Fax: 908-580-2544 |