Healthcare Provider Details

I. General information

NPI: 1720235385
Provider Name (Legal Business Name): ELINA SHRAYMAN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2008
Last Update Date: 03/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 POMPTON AVE
VERONA NJ
07044-2917
US

IV. Provider business mailing address

118 POMPTON AVE
VERONA NJ
07044-2917
US

V. Phone/Fax

Practice location:
  • Phone: 973-239-3555
  • Fax:
Mailing address:
  • Phone: 973-985-3854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV007293
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number27OA00617200
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number27OA00617200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: