Provider Demographics
NPI:1629108220
Name:EDWARD S. MASLANSKY
Entity Type:Organization
Organization Name:EDWARD S. MASLANSKY
Other - Org Name:EDWARD MASLANSKY & ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:MASLANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:732-671-7451
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:2007-03-06
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00407901152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0694207Medicaid
NJT82491Medicare UPIN
NJ721218Medicare ID - Type Unspecified
NJ0694207Medicaid