Provider Demographics
NPI:1942472741
Name:MAIMONE VISION ASSOCIATES, LLC
Entity Type:Organization
Organization Name:MAIMONE VISION ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRYLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAIMONE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:973-685-7280
Mailing Address - Street 1:27 DEVONSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-2662
Mailing Address - Country:US
Mailing Address - Phone:973-685-7280
Mailing Address - Fax:
Practice Address - Street 1:1135 MAIN AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-2353
Practice Address - Country:US
Practice Address - Phone:973-685-7280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ518967OtherAETNA
NJ2K3806OtherHEALTHNET
NJ6018700Medicaid
NJ2319156OtherUNITED HEALTHCARE
NJ518967OtherAETNA
NJ6018700Medicaid