Provider Demographics
NPI:1700017951
Name:JERSEY GARDENS OPTICAL, LLL
Entity Type:Organization
Organization Name:JERSEY GARDENS OPTICAL, LLL
Other - Org Name:COHEN'S FASHION OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/FRANCHISEE
Authorized Official - Prefix:MR
Authorized Official - First Name:YAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VAYNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-354-1599
Mailing Address - Street 1:651 KAPKOWSKI RD
Mailing Address - Street 2:SUITE 1236
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07201-4901
Mailing Address - Country:US
Mailing Address - Phone:908-354-1599
Mailing Address - Fax:908-354-1344
Practice Address - Street 1:651 KAPKOWSKI RD
Practice Address - Street 2:SUITE 1236
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07201-4901
Practice Address - Country:US
Practice Address - Phone:908-354-1599
Practice Address - Fax:908-354-1344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31TD00325201156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty