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General NPI Number Information
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NPI Number | 1083094635
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Entity Type | Individual
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Provider Name | IVAN TSENG O.D.
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Gender | Male
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Dates
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Enumeration Date | 06/08/2015
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Last Update Date | 10/19/2022
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Provider Practice Location Address
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Address Line | 1200 E RIDGEWOOD AVE STE 213
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-3937
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Country | US
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Telephone | 201-612-0044
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Fax |
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Provider Business Mailing Address
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Address Line | 431 WESTVIEW PL
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City | FORT LEE
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State | NJ
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Zip | 07024-3916
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Country | US
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Telephone | 201-966-4272
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 27OM00136800
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TUV008161-1
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 27OA00669100
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License Number State | NJ
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