Healthcare Provider Details

I. General information

NPI: 1730217365
Provider Name (Legal Business Name): ANGRIST OPTICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 10/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1527 STATE ROUTE 27 STE 2600
SOMERSET NJ
08873-3979
US

IV. Provider business mailing address

1527 STATE ROUTE 27 STE 2600
SOMERSET NJ
08873-3979
US

V. Phone/Fax

Practice location:
  • Phone: 732-246-1050
  • Fax:
Mailing address:
  • Phone: 732-246-1050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number25MA04389500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number25MA04389500
License Number StateNJ

VIII. Authorized Official

Name: DR. RICHARD C ANGRIST
Title or Position: PRESIDENT
Credential: MD
Phone: 732-246-1050