Healthcare Provider Details

I. General information

NPI: 1619238326
Provider Name (Legal Business Name): WYCKOFF OPHTHALMOLOGY,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2012
Last Update Date: 04/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 FRANKLIN AVE
WYCKOFF NJ
07481-1909
US

IV. Provider business mailing address

350 FRANKLIN AVE
WYCKOFF NJ
07481-1909
US

V. Phone/Fax

Practice location:
  • Phone: 201-891-0200
  • Fax: 201-891-9388
Mailing address:
  • Phone: 201-891-0200
  • Fax: 201-891-9388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMA62183
License Number StateNJ

VIII. Authorized Official

Name: DR. MELANIE A SINATRA
Title or Position: OWNER
Credential: MD
Phone: 201-891-0200