Healthcare Provider Details

I. General information

NPI: 1053397679
Provider Name (Legal Business Name): SUSSKIND & ALMALLAH EYE ASSOC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 04/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 MULE RD
TOMS RIVER NJ
08755-5028
US

IV. Provider business mailing address

20 MULE RD
TOMS RIVER NJ
08755-5028
US

V. Phone/Fax

Practice location:
  • Phone: 732-914-1499
  • Fax: 732-349-5625
Mailing address:
  • Phone: 732-914-1499
  • Fax: 732-349-5625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number31TD00215900
License Number StateNJ

VIII. Authorized Official

Name: DR. OMAR F ALMALLAH
Title or Position: PRESIDENT
Credential: MD
Phone: 732-914-1499