Healthcare Provider Details

I. General information

NPI: 1598968075
Provider Name (Legal Business Name): MATTHEW J MARANO JR MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 09/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

556 EAGLE ROCK AVE SUITE 204
ROSELAND NJ
07068-1503
US

IV. Provider business mailing address

PO BOX 7198
BEDMINSTER NJ
07921-7198
US

V. Phone/Fax

Practice location:
  • Phone: 973-468-1810
  • Fax: 973-467-1873
Mailing address:
  • Phone: 973-467-1810
  • Fax: 973-467-4225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MA04054400
License Number StateNJ

VIII. Authorized Official

Name: DR. MATTHEW J MARANO JR JR.
Title or Position: OPHTHALMOLOGIST
Credential: MD
Phone: 973-467-1810