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General NPI Number Information
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NPI Number | 1053475046
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Entity Type | Organization
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Legal Business Name | J KELLEY AND HINDA L LIEBESKIND PTR
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Dates
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Enumeration Date | 12/21/2006
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Last Update Date | 01/14/2008
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Provider Practice Location Address
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Address Line | 1727 RT 27
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City | SOMERSET
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State | NJ
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Zip | 08873
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Country | US
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Telephone | 732-249-2020
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Fax | 732-249-6006
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Provider Business Mailing Address
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Address Line | 1727 RT 27
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City | SOMERSET
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State | NJ
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Zip | 08873
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Country | US
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Telephone | 732-249-2020
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Fax | 732-249-6006
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Authorized Official
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Title or Position | CO OWNER
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Name | MR. JAMES P KELLEY
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Credential | OD
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Telephone | 732-249-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State | NJ
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