Provider Demographics
NPI:1992783864
Name:SERGIO MARANO O.D. MARK GRISAR O.D. PC
Entity type:Organization
Organization Name:SERGIO MARANO O.D. MARK GRISAR O.D. PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARANO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:914-961-1004
Mailing Address - Street 1:1765 CENTRAL PARK AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-2828
Mailing Address - Country:US
Mailing Address - Phone:914-961-1004
Mailing Address - Fax:914-961-7636
Practice Address - Street 1:1765 CENTRAL PARK AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-2828
Practice Address - Country:US
Practice Address - Phone:914-961-1004
Practice Address - Fax:914-961-7636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-02
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC0W781Medicare PIN