Healthcare Provider Details

I. General information

NPI: 1003220351
Provider Name (Legal Business Name): YULIA NAUMOVA OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2014
Last Update Date: 12/23/2019
Certification Date: 12/23/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PARK PL
SECAUCUS NJ
07094-3654
US

IV. Provider business mailing address

234 KNOX AVE UNIT B
CLIFFSIDE PARK NJ
07010-2510
US

V. Phone/Fax

Practice location:
  • Phone: 201-421-9321
  • Fax:
Mailing address:
  • Phone: 201-421-9321
  • Fax: 201-945-3470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC 5037
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00652600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: