Healthcare Provider Details

I. General information

NPI: 1891936027
Provider Name (Legal Business Name): GEFEN OPTICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2009
Last Update Date: 03/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 GEFEN DR
LAKEWOOD NJ
08701-3596
US

IV. Provider business mailing address

30 GEFEN DR
LAKEWOOD NJ
08701-3596
US

V. Phone/Fax

Practice location:
  • Phone: 732-363-7505
  • Fax: 732-363-2750
Mailing address:
  • Phone: 732-363-7505
  • Fax: 732-363-2750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number31TD00356800
License Number StateNJ

VIII. Authorized Official

Name: ESTHER M BLUMENKRANTZ
Title or Position: OWNER
Credential:
Phone: 732-363-7505