Provider Demographics
NPI:1053397679
Name:SUSSKIND & ALMALLAH EYE ASSOC
Entity type:Organization
Organization Name:SUSSKIND & ALMALLAH EYE ASSOC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:F
Authorized Official - Last Name:ALMALLAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-914-1499
Mailing Address - Street 1:20 MULE RD
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-5028
Mailing Address - Country:US
Mailing Address - Phone:732-914-1499
Mailing Address - Fax:732-349-5625
Practice Address - Street 1:20 MULE RD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-5028
Practice Address - Country:US
Practice Address - Phone:732-914-1499
Practice Address - Fax:732-349-5625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-15
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31TD00215900332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0329420001Medicare NSC