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General NPI Number Information
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NPI Number | 1851528772
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Entity Type | Organization
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Legal Business Name | DAVID IOSEBASHVILI PC
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Dates
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Enumeration Date | 06/18/2009
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Last Update Date | 06/18/2009
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Provider Practice Location Address
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Address Line | 106 FERRY STR
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City | NEWARK
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State | NJ
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Zip | 07105
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Country | US
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Telephone | 973-589-7369
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Fax | 973-589-2891
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Provider Business Mailing Address
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Address Line | 1315 ANDERSON AVE UNITE #28
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City | FORT LEE
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State | NJ
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Zip | 07024
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Country | US
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Telephone | 973-589-7369
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Fax | 973-589-2891
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID IOSEBASHVILI
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Credential | O.D.
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Telephone | 973-589-7369
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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 |
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License Number State |
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