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NPI Code Detail

MEDICARE: EPIFANIO I SUNGA OD PA

MEDICARE: EPIFANIO I SUNGA OD PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist27OA00604000NJ

General Provider Information

NPI Number : 1043365182
Entity Type Code : Organization
Provider Name (Legal Business Name) : EPIFANIO I SUNGA OD PA
Provider Business Mailing Address
First Line : 125 WASHINGTON AVE
Second Line :
City : DUMONT
State : NJ
Zip : 07628-3066
Country : US
Telephone Number : 201-385-3055
Fax Number :
Provider Business Practice Location Address
First Line : 125 WASHINGTON AVE
Second Line :
City : DUMONT
State : NJ
Zip : 07628-3066
Country : US
Telephone Number : 201-385-3055
Fax Number :
Authorized Official
Title or Position : OPTOMETRIST
Name : DR. EPIFANIO I. SUNGA
Credential : O.D.
Telephone Number : 201-244-6563
Provider Enumeration Date : 01/25/2007
Last Update Date : 12/29/2008

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