Healthcare Provider Details

I. General information

NPI: 1366614893
Provider Name (Legal Business Name): STUART M LONSK OD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2008
Last Update Date: 08/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

579 RARITAN ROAD SUITE A
ROSELLE NJ
07203-2445
US

IV. Provider business mailing address

579 RARITAN ROAD 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 Number270A00299300
License Number StateNJ

VIII. Authorized Official

Name: DR. STUART MARTIN LONSK
Title or Position: PRESIDENT
Credential: OD
Phone: 908-241-5777