Provider Demographics
NPI:1346377520
Name:I. DAVID NESTOROWICZ L.L.C.
Entity Type:Organization
Organization Name:I. DAVID NESTOROWICZ L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:NESTOROWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:732-431-1004
Mailing Address - Street 1:4345 US RT 9 NORTH
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728
Mailing Address - Country:US
Mailing Address - Phone:732-431-1004
Mailing Address - Fax:732-431-1006
Practice Address - Street 1:4345 US RT 9 NORTH
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728
Practice Address - Country:US
Practice Address - Phone:732-431-1004
Practice Address - Fax:732-431-1006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ270A00607300152W00000X
332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ123664Medicare PIN