MEDICARE: MARALYNN RADIN OPTICIAN

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	156FX1800X	Optician	TD2066	NJ

General Provider Information

NPI Number	:	1821237595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARALYNN RADIN OPTICIAN

Provider Business Mailing Address
First Line	:	240 ROCK RD
Second Line	:
City	:	GLEN ROCK
State	:	NJ
Zip	:	07452-1738
Country	:	US
Telephone Number	:	201-251-0737
Fax Number	:

Provider Business Practice Location Address
First Line	:	240 ROCK RD
Second Line	:
City	:	GLEN ROCK
State	:	NJ
Zip	:	07452-1738
Country	:	US
Telephone Number	:	201-251-0737
Fax Number	:

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

Provider Enumeration Date	:	02/19/2009
Last Update Date	:	02/19/2009

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