Provider Demographics
NPI:1598968075
Name:MATTHEW J MARANO JR MD
Entity Type:Organization
Organization Name:MATTHEW J MARANO JR MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPHTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARANO JR
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:973-467-1810
Mailing Address - Street 1:PO BOX 7198
Mailing Address - Street 2:
Mailing Address - City:BEDMINSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07921-7198
Mailing Address - Country:US
Mailing Address - Phone:973-467-1810
Mailing Address - Fax:973-467-4225
Practice Address - Street 1:556 EAGLE ROCK AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:ROSELAND
Practice Address - State:NJ
Practice Address - Zip Code:07068-1503
Practice Address - Country:US
Practice Address - Phone:973-468-1810
Practice Address - Fax:973-467-1873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04054400174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1388509Medicaid
NJ1388509Medicaid
NJD18611Medicare UPIN