Provider Demographics
NPI:1457400020
Name:HOLIDAY OPTICIANS INC
Entity Type:Organization
Organization Name:HOLIDAY OPTICIANS INC
Other - Org Name:HOLIDAY PLAZA HEARING & MANASQUAN HEARING AID CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:D
Authorized Official - Last Name:LOSSEFF
Authorized Official - Suffix:
Authorized Official - Credentials:LIC HEARING AID DISP
Authorized Official - Phone:732-349-6663
Mailing Address - Street 1:3 PLAZA DRIVE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08757-3759
Mailing Address - Country:US
Mailing Address - Phone:732-349-6663
Mailing Address - Fax:732-349-8803
Practice Address - Street 1:3 PLAZA DRIVE
Practice Address - Street 2:SUITE 8
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08757-3759
Practice Address - Country:US
Practice Address - Phone:732-349-6663
Practice Address - Fax:732-349-8803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MG00033700332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ$$$$$$$$$OtherSSN
NJ178870140Medicaid
NJ1788701Medicaid
NJ178870140Medicaid
240059QGSMedicare ID - Type UnspecifiedANTHONY RELLA
05235QGSMedicare ID - Type UnspecifiedRENEE FONTANELLA
NJ1788701Medicaid