Provider Demographics
NPI:1336445386
Name:NATHAN T DEDEO AND ASSOCIATES INC
Entity Type:Organization
Organization Name:NATHAN T DEDEO AND ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:DEDEO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:917-670-9511
Mailing Address - Street 1:19 HUNT PL
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-3709
Mailing Address - Country:US
Mailing Address - Phone:973-535-1171
Mailing Address - Fax:973-535-9440
Practice Address - Street 1:112 EISENHOWER PKWY
Practice Address - Street 2:SUITE 2020
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-4995
Practice Address - Country:US
Practice Address - Phone:973-535-1171
Practice Address - Fax:973-535-9440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-08
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00600100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty