=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922786870
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GEORGINA MARIA BATTIPAGLIA O.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2023
-----------------------------------------------------
Last Update Date | 07/10/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 89 N MAPLE AVE
-----------------------------------------------------
City | RIDGEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07450-3235
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-445-1991
-----------------------------------------------------
Fax | 201-445-4827
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 89 N MAPLE AVE STE 5
-----------------------------------------------------
City | RIDGEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07450-3235
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-445-1991
-----------------------------------------------------
Fax | 201-445-4827
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 27OA00721100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------