Healthcare Provider Details

I. General information

NPI: 1275381733
Provider Name (Legal Business Name): ALYSSA ZOLL OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALYSSA R ZOLL OD

II. Dates (important events)

Enumeration Date: 05/09/2024
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 DAYTON ST STE 2
RIDGEWOOD NJ
07450-5146
US

IV. Provider business mailing address

190 DAYTON ST STE 2
RIDGEWOOD NJ
07450-5146
US

V. Phone/Fax

Practice location:
  • Phone: 201-444-3173
  • Fax:
Mailing address:
  • Phone: 201-444-3173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00739100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: