Provider Demographics
NPI:1912166976
Name:MAPLE EYE CARE ASSOCIATES PA
Entity Type:Organization
Organization Name:MAPLE EYE CARE ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:J
Authorized Official - Last Name:PALLOTTA
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:201-444-3173
Mailing Address - Street 1:195 S MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-5142
Mailing Address - Country:US
Mailing Address - Phone:201-444-3173
Mailing Address - Fax:201-251-4868
Practice Address - Street 1:195 S MAPLE AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-5142
Practice Address - Country:US
Practice Address - Phone:201-444-3173
Practice Address - Fax:201-251-4868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0A2423152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ521245Medicare PIN
NJU26838Medicare UPIN