Provider Demographics
NPI:1154393338
Name:ARIOLA, JENNIFER JOYCE (OD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:JOYCE
Last Name:ARIOLA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 STRATFORD RD
Mailing Address - Street 2:
Mailing Address - City:DUMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:07628-1124
Mailing Address - Country:US
Mailing Address - Phone:201-787-5594
Mailing Address - Fax:973-473-5151
Practice Address - Street 1:287-289 MONROE ST
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055
Practice Address - Country:US
Practice Address - Phone:973-473-5151
Practice Address - Fax:973-473-3331
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00599200152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0084140Medicaid
NJ0084140Medicaid
NJ095877TCMMedicare PIN