Provider Demographics
NPI:1902249584
Name:NADBORNY, CHAIM (DO)
Entity type:Individual
Prefix:MR
First Name:CHAIM
Middle Name:
Last Name:NADBORNY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-5500
Mailing Address - Country:US
Mailing Address - Phone:973-778-7773
Mailing Address - Fax:973-778-7773
Practice Address - Street 1:212 MAIN AVE
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-5500
Practice Address - Country:US
Practice Address - Phone:973-778-7773
Practice Address - Fax:973-778-7773
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-12
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31TD00210600156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician