Provider Demographics
NPI:1790875946
Name:MARCOLINI, JAIME BLYSKAL (OD)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:BLYSKAL
Last Name:MARCOLINI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:
Other - Last Name:MARCOLINI-BLYSKAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:186 CENTER ST STE 170
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08809-1385
Mailing Address - Country:US
Mailing Address - Phone:908-735-5712
Mailing Address - Fax:
Practice Address - Street 1:186 CENTER ST STE 170
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NJ
Practice Address - Zip Code:08809-1385
Practice Address - Country:US
Practice Address - Phone:908-735-5712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00573300152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ866202Medicaid
NJ866202Medicaid
NJ050179QA2Medicare PIN