Provider Demographics
NPI:1578627162
Name:DEYONG, ALAN JAY (OD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:JAY
Last Name:DEYONG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 ST. GEORGES AVENUE
Mailing Address - Street 2:
Mailing Address - City:COLONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07067-4049
Mailing Address - Country:US
Mailing Address - Phone:732-634-8600
Mailing Address - Fax:732-283-0263
Practice Address - Street 1:1009 ST. GEORGES AVENUE
Practice Address - Street 2:
Practice Address - City:COLONIA
Practice Address - State:NJ
Practice Address - Zip Code:07067-4049
Practice Address - Country:US
Practice Address - Phone:732-634-8600
Practice Address - Fax:732-283-0263
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ270A00375500152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU06332Medicare UPIN
NJ636638YG45Medicare PIN