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General NPI Number Information
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NPI Number | 1578298535
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Entity Type | Organization
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Legal Business Name | EYEWELLNISS
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Dates
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Enumeration Date | 07/22/2022
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Last Update Date | 08/10/2023
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Provider Practice Location Address
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Address Line | 112 EISENHOWER PKWY STE 44
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City | LIVINGSTON
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State | NJ
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Zip | 07039-4900
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Country | US
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Telephone | 973-535-3344
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Fax |
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Provider Business Mailing Address
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Address Line | 2 12TH ST APT PH07
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City | HOBOKEN
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State | NJ
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Zip | 07030-6785
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Country | US
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Telephone | 321-537-9976
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | DR. JORDAN NISSINOFF
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Credential |
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Telephone | 321-537-9976
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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