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General NPI Number Information
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NPI Number | 1891934717
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Entity Type | Organization
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Legal Business Name | MMA OPTICAL INC
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Dates
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Enumeration Date | 02/17/2009
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Last Update Date | 02/17/2009
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Provider Practice Location Address
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Address Line | 412 HEMPSTEAD TPKE SUITE #1
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City | WEST HEMPSTEAD
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State | NY
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Zip | 11552-1336
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Country | US
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Telephone | 516-204-7733
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Fax | 516-481-0727
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Provider Business Mailing Address
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Address Line | 412 HEMPSTEAD TPKE SUITE #1
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City | WEST HEMPSTEAD
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State | NY
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Zip | 11552-1336
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Country | US
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Telephone | 516-204-7733
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MARIANA GERSHOVICH
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Credential |
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Telephone | 516-204-7733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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