Healthcare Provider Details

I. General information

NPI: 1982912234
Provider Name (Legal Business Name): DANNMARK INC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2010
Last Update Date: 09/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 PARSONAGE RD UNIT 368 MENLO PARK MALL
EDISON NJ
08837-2480
US

IV. Provider business mailing address

55 PARSONAGE RD UNIT 368 MENLO PARK MALL
EDISON NJ
08837-2480
US

V. Phone/Fax

Practice location:
  • Phone: 732-906-8081
  • Fax: 732-906-7995
Mailing address:
  • Phone: 732-906-8081
  • Fax: 732-906-7995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier09212010
Identifier TypeOTHER
Identifier State
Identifier IssuerAPP DATE

VIII. Authorized Official

Name: ALBINA KROYTOR
Title or Position: OWNER
Credential:
Phone: 732-906-8081