Provider Demographics
NPI:1245437755
Name:TERRYLEE MAIMONE O.D, P.C
Entity type:Organization
Organization Name:TERRYLEE MAIMONE O.D, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
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:201-703-2922
Mailing Address - Street 1:32-01 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-4616
Mailing Address - Country:US
Mailing Address - Phone:201-703-2922
Mailing Address - Fax:201-791-6626
Practice Address - Street 1:32-01 BROADWAY
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-4616
Practice Address - Country:US
Practice Address - Phone:201-703-2922
Practice Address - Fax:201-791-6626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27TO00040600152WV0400X
NJ27OA00490500152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC228E1OtherEMPIRE BCBS
NJ5452503OtherCCN
NJ177820OtherCHN
NJ2319156OtherUNITED HEALTHCARE
NJ2K3806OtherHEALTHNET
NJP2865102OtherOXFORD
NJ2099723OtherFIRST HEALTH
NJ518967OtherAETNA
NJ4495272OtherCIGNA
NJ6018700Medicaid
NJC228E1OtherEMPIRE BCBS
NJ5452503OtherCCN
NJ4495272OtherCIGNA
NJ5452503OtherCCN
NJ6018700Medicaid