Healthcare Provider Details

I. General information

NPI: 1538514377
Provider Name (Legal Business Name): MOHANNAD ZINDAKI L.D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2016
Last Update Date: 09/01/2016
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:
Mailing address:
  • Phone: 201-651-1212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number31TD00378400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: