Basic Information
| Provider Information | |||||||||
| NPI: | 1639350424 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MARK ZALESKI T/A ALBERT MINELLI OPTICIANS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 55 SPARTA AVE | ||||||||
| Address2: | |||||||||
| City: | SPARTA | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 078711815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737293839 | ||||||||
| FaxNumber: | 9737260651 | ||||||||
| Practice Location | |||||||||
| Address1: | 55 SPARTA AVE | ||||||||
| Address2: | |||||||||
| City: | SPARTA | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 078711815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737293839 | ||||||||
| FaxNumber: | 9737260651 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2007 | ||||||||
| LastUpdateDate: | 06/17/2008 | ||||||||
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| AuthorizedOfficialLastName: | ZALESKI | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9737293839 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.