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General NPI Number Information
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NPI Number | 1356561526
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Entity Type | Organization
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Legal Business Name | PICILLO BROTHERS OPTICIANS OF LYNDHURTS INC
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Dates
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Enumeration Date | 04/27/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 312 RIDGE ROAD
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City | LYNDHURST
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State | NJ
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Zip | 07071
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Country | US
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Telephone | 201-933-1666
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Fax | 201-507-0557
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Provider Business Mailing Address
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Address Line | PO BOX 365 312 RIDGE ROAD
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City | LYNDHURST
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State | NJ
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Zip | 07071
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Country | US
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Telephone | 201-933-1666
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Fax | 201-507-0557
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. WILLIAM PHILIP PICILLO
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Credential | OPTICIAN
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Telephone | 201-933-1666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | D1529
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License Number State | NJ
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