Provider Demographics
NPI:1265436091
Name:MAIMONE, TERRYLEE (OD)
Entity type:Individual
Prefix:DR
First Name:TERRYLEE
Middle Name:
Last Name:MAIMONE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 WILLIAMS CT
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-1630
Mailing Address - Country:US
Mailing Address - Phone:201-703-8644
Mailing Address - Fax:
Practice Address - Street 1:7000 BOULEVARD EAST
Practice Address - Street 2:
Practice Address - City:GUTTENBERG
Practice Address - State:NJ
Practice Address - Zip Code:07093-4818
Practice Address - Country:US
Practice Address - Phone:201-854-3489
Practice Address - Fax:201-854-3298
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00490500152W00000X
NJ27TO00040600152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJTM23689OtherSPECTERA
NJ518967OtherAETNA
NJ223828037OtherPHCS
NJ2319156OtherUNITED HEALTHCARE
NJ177820OtherCHN
NJ2K3806OtherHEALTHNET
NJ6018700Medicaid
NJ223828037OtherMULTI-PLAN
NJP2865102OtherOXFORD
NJ555558OtherCLARITY VISION
NJC228E1OtherEMPIRE BCBS
NJ2099723OtherFIRST HEALTH
NJ223828037OtherHORIZON
NJ4495272OtherCIGNA
NJ5452503OtherCCN
NJC228E1OtherEMPIRE BCBS
NJ6018700Medicaid