Healthcare Provider Details

I. General information

NPI: 1841453529
Provider Name (Legal Business Name): MARIANNE B CIDIS OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 MAPLE AVENUE
MORRISTOWN NJ
07960
US

IV. Provider business mailing address

50 MAPLE AVENUE
MORRISTOWN NJ
07960
US

V. Phone/Fax

Practice location:
  • Phone: 973-285-1105
  • Fax:
Mailing address:
  • Phone: 973-285-1105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License NumberOA05415
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: