MEDICARE: MADHUSMITA DEKA

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
1	152W00000X	Optometrist	27OA00682500	NJ

General Provider Information

NPI Number	:	1184101545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADHUSMITA DEKA

Provider Business Mailing Address
First Line	:	134 KINGSLAND RD
Second Line	:
City	:	CLIFTON
State	:	NJ
Zip	:	07014-1915
Country	:	US
Telephone Number	:	862-276-3173
Fax Number	:

Provider Business Practice Location Address
First Line	:	134 KINGSLAND RD # 3
Second Line	:
City	:	CLIFTON
State	:	NJ
Zip	:	07014-1915
Country	:	US
Telephone Number	:	973-405-2548
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2018
Last Update Date	:	02/17/2020

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Directions to “ MADHUSMITA DEKA ” Practice Location

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