Provider Demographics
NPI:1649601238
Name:IAROSSI, LAILA (OPHTHALMIC DISPENSER)
Entity Type:Individual
Prefix:
First Name:LAILA
Middle Name:
Last Name:IAROSSI
Suffix:
Gender:F
Credentials:OPHTHALMIC DISPENSER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:286 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07407-2014
Mailing Address - Country:US
Mailing Address - Phone:201-797-5835
Mailing Address - Fax:201-797-2066
Practice Address - Street 1:286 MARKET ST
Practice Address - Street 2:
Practice Address - City:ELMWOOD PARK
Practice Address - State:NJ
Practice Address - Zip Code:07407-2014
Practice Address - Country:US
Practice Address - Phone:201-797-5835
Practice Address - Fax:201-797-2066
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-06
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31TD00311100156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician