Healthcare Provider Details

I. General information

NPI: 1336434711
Provider Name (Legal Business Name): FARES SABBAGH OPTICIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2011
Last Update Date: 06/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 RAMAPO VALLEY RD
OAKLAND NJ
07436-2702
US

IV. Provider business mailing address

350 RAMAPO VALLEY RD
OAKLAND NJ
07436-2702
US

V. Phone/Fax

Practice location:
  • Phone: 201-651-1212
  • Fax: 201-644-8803
Mailing address:
  • Phone: 201-651-1212
  • Fax: 201-644-8803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number1730
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: