Basic Information
| Provider Information | |||||||||
| NPI: | 1609199256 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ICENTRAL OPHTHALMOLOGY, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 826 | ||||||||
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| City: | FRANKLIN LAKES | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074170826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737689692 | ||||||||
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| Practice Location | |||||||||
| Address1: | 785 FRANKLIN AVE | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN LAKES | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074170826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 0000000000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2010 | ||||||||
| LastUpdateDate: | 02/01/2019 | ||||||||
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| AuthorizedOfficialLastName: | GATTO | ||||||||
| AuthorizedOfficialFirstName: | MICHELE | ||||||||
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| AuthorizedOfficialTitleorPosition: | M.D. | ||||||||
| AuthorizedOfficialTelephone: | 9737689692 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.