Provider Demographics
NPI:1982133484
Name:BESHAI, MARIO (OD)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:BESHAI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:746 MIDLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-7426
Mailing Address - Country:US
Mailing Address - Phone:908-956-4711
Mailing Address - Fax:
Practice Address - Street 1:1300 US HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-4108
Practice Address - Country:US
Practice Address - Phone:908-454-9890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2020-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00673400152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist