Provider Demographics
NPI:1124133145
Name:NAYMAGON, VALERY (OPHTHALMIC DISPENSER)
Entity type:Individual
Prefix:MR
First Name:VALERY
Middle Name:
Last Name:NAYMAGON
Suffix:
Gender:M
Credentials:OPHTHALMIC DISPENSER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3108 NOSTRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-2601
Mailing Address - Country:US
Mailing Address - Phone:718-594-2793
Mailing Address - Fax:908-289-3713
Practice Address - Street 1:240 WILLIAMSON ST
Practice Address - Street 2:SUITE 505
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-3674
Practice Address - Country:US
Practice Address - Phone:908-289-0250
Practice Address - Fax:908-289-3713
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31TD00337700156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ31TD00337700OtherOPHTHALMIC DISPENSER #