Provider Demographics
NPI:1104817998
Name:MARIANI, FREDRICK C (OD)
Entity type:Individual
Prefix:DR
First Name:FREDRICK
Middle Name:C
Last Name:MARIANI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:ALPHA
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-4525
Mailing Address - Country:US
Mailing Address - Phone:908-859-4433
Mailing Address - Fax:908-859-1887
Practice Address - Street 1:901 3RD AVE
Practice Address - Street 2:
Practice Address - City:ALPHA
Practice Address - State:NJ
Practice Address - Zip Code:08865-4525
Practice Address - Country:US
Practice Address - Phone:908-859-4433
Practice Address - Fax:908-859-1887
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3444152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7852Medicare ID - Type Unspecified
NJ0358670001Medicare NSC