Provider Demographics
NPI:1063798320
Name:MAPLEWOOD VISION CARE, LLC
Entity type:Organization
Organization Name:MAPLEWOOD VISION CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:DELESIO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:973-761-5313
Mailing Address - Street 1:1955 SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-3441
Mailing Address - Country:US
Mailing Address - Phone:973-761-5313
Mailing Address - Fax:
Practice Address - Street 1:1955 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-3441
Practice Address - Country:US
Practice Address - Phone:973-761-5313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-31
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00375400152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ521416Medicare UPIN
NJ97313Medicare PIN