Provider Demographics
NPI:1578338406
Name:MARISSA ISRAEL, O.D., LLC
Entity Type:Organization
Organization Name:MARISSA ISRAEL, O.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:BROOKE
Authorized Official - Last Name:ISRAEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:917-806-3153
Mailing Address - Street 1:399 KEARNY AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-2603
Mailing Address - Country:US
Mailing Address - Phone:201-991-0026
Mailing Address - Fax:201-991-4989
Practice Address - Street 1:399 KEARNY AVE
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-2603
Practice Address - Country:US
Practice Address - Phone:201-991-0026
Practice Address - Fax:201-991-4989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-21
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty