Provider Demographics
NPI:1417211400
Name:MICHAEL A. FALCONE, ODPA
Entity Type:Organization
Organization Name:MICHAEL A. FALCONE, ODPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:FALCONE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:908-233-0034
Mailing Address - Street 1:502 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-2116
Mailing Address - Country:US
Mailing Address - Phone:908-233-0034
Mailing Address - Fax:908-233-9919
Practice Address - Street 1:502 E BROAD ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-2116
Practice Address - Country:US
Practice Address - Phone:908-233-0034
Practice Address - Fax:908-233-9919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJAOA3956152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1598856619OtherNPI