Provider Demographics
NPI:1710429089
Name:NOOR, TASNIM (OD)
Entity Type:Individual
Prefix:
First Name:TASNIM
Middle Name:
Last Name:NOOR
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 1:90 CHRISTOPHER COLUMBUS DR APT 2802
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-5714
Mailing Address - Country:US
Mailing Address - Phone:954-224-8642
Mailing Address - Fax:
Practice Address - Street 1:651 KAPKOWSKI RD STE 1240
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07201-4903
Practice Address - Country:US
Practice Address - Phone:908-249-4047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-17
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.011073152W00000X
NY008743152W00000X
NJ27OA00678900152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist