MEDICARE: DR. TERRYLEE MAIMONE O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	27OA00490500	NJ
2	152WV0400X	Vision Therapy Optometrist	27TO00040600	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	TM23689	OTHER	NJ	SPECTERA
2	518967	OTHER	NJ	AETNA
3	223828037	OTHER	NJ	PHCS
4	2319156	OTHER	NJ	UNITED HEALTHCARE
5	177820	OTHER	NJ	CHN
6	2K3806	OTHER	NJ	HEALTHNET
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	223828037	OTHER	NJ	MULTI-PLAN
9	P2865102	OTHER	NJ	OXFORD
10	555558	OTHER	NJ	CLARITY VISION
11	C228E1	OTHER	NJ	EMPIRE BCBS
12	2099723	OTHER	NJ	FIRST HEALTH
13	223828037	OTHER	NJ	HORIZON
14	4495272	OTHER	NJ	CIGNA
15	5452503	OTHER	NJ	CCN

General Provider Information

NPI Number	:	1265436091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERRYLEE MAIMONE O.D.

Provider Business Mailing Address
First Line	:	503 WILLIAMS CT
Second Line	:
City	:	EDGEWATER
State	:	NJ
Zip	:	07020-1630
Country	:	US
Telephone Number	:	201-703-8644
Fax Number	:

Provider Business Practice Location Address
First Line	:	7000 BOULEVARD EAST
Second Line	:
City	:	GUTTENBERG
State	:	NJ
Zip	:	07093-4818
Country	:	US
Telephone Number	:	201-854-3489
Fax Number	:	201-854-3298

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	04/02/2014

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