Provider Demographics
NPI:1386750040
Name:PIAZZA, EMANUEL JR (OPTHALMIC DISPENSER)
Entity type:Individual
Prefix:MR
First Name:EMANUEL
Middle Name:
Last Name:PIAZZA
Suffix:JR
Gender:M
Credentials:OPTHALMIC DISPENSER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:25 ELM ST STE 3
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-1452
Mailing Address - Country:US
Mailing Address - Phone:845-987-7333
Mailing Address - Fax:845-986-9040
Practice Address - Street 1:25 ELM ST
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-1455
Practice Address - Country:US
Practice Address - Phone:845-987-7333
Practice Address - Fax:845-986-9040
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5273156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician