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General NPI Number Information
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NPI Number | 1336445386
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Entity Type | Organization
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Legal Business Name | NATHAN T DEDEO AND ASSOCIATES INC
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Dates
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Enumeration Date | 02/08/2011
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Last Update Date | 03/02/2011
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Provider Practice Location Address
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Address Line | 112 EISENHOWER PKWY SUITE 2020
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City | LIVINGSTON
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State | NJ
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Zip | 07039-4995
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Country | US
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Telephone | 973-535-1171
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Fax | 973-535-9440
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Provider Business Mailing Address
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Address Line | 19 HUNT PL 1ST FLOOR
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City | NUTLEY
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State | NJ
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Zip | 07110-3709
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Country | US
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Telephone | 973-535-1171
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Fax | 973-535-9440
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Authorized Official
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Title or Position | OWNER
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Name | DR. NATHAN T. DEDEO
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Credential | OD
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Telephone | 917-670-9511
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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 | 27OA00600100
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License Number State | NJ
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