Healthcare Provider Details

I. General information

NPI: 1053314658
Provider Name (Legal Business Name): STUART MARTIN LONSK O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 08/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

579 RARITAN RD SUITE A
ROSELLE NJ
07203-2445
US

IV. Provider business mailing address

579 RARITAN RD SUITE A
ROSELLE NJ
07203-2445
US

V. Phone/Fax

Practice location:
  • Phone: 908-241-5777
  • Fax: 908-241-6690
Mailing address:
  • Phone: 908-241-5777
  • Fax: 908-241-6690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00299300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: