Provider Demographics
NPI:1568526234
Name:CARDONA, MARIA I (OD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:I
Last Name:CARDONA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 S PARAMUS RD
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-1232
Mailing Address - Country:US
Mailing Address - Phone:201-712-0101
Mailing Address - Fax:201-712-0123
Practice Address - Street 1:74 S PARAMUS RD
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-1232
Practice Address - Country:US
Practice Address - Phone:201-712-0101
Practice Address - Fax:201-712-0123
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00512400152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ694462Medicare PIN