Provider Demographics
NPI:1194772566
Name:GILIBERTI EYE AND LASER CENTER P C
Entity type:Organization
Organization Name:GILIBERTI EYE AND LASER CENTER P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ORAZIO
Authorized Official - Middle Name:L
Authorized Official - Last Name:GILIBERTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-595-0011
Mailing Address - Street 1:415 TOTOWA ROAD
Mailing Address - Street 2:
Mailing Address - City:TOTOWA
Mailing Address - State:NJ
Mailing Address - Zip Code:07512
Mailing Address - Country:US
Mailing Address - Phone:973-595-0011
Mailing Address - Fax:973-595-5155
Practice Address - Street 1:415 TOTOWA ROAD
Practice Address - Street 2:
Practice Address - City:TOTOWA
Practice Address - State:NJ
Practice Address - Zip Code:07512
Practice Address - Country:US
Practice Address - Phone:973-595-0011
Practice Address - Fax:973-595-5155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04637500207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ092665Medicare ID - Type Unspecified
C55586Medicare UPIN