Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 31TD00358300 | NJ |
NPI | 1063910511 |
---|---|
Provider Name | Carmelo Belardo JR. |
First Address | Lakewood, NJ 08701-5659 |
Second Address | Lakewood, NJ 08701-5659 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2018 |
Last Update Date | 30/01/2018 |