Organization
MICHAEL A BENETATOS OD LLC
Active
Other names
Haskell Eye Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL BENETATOS O.D. (OPERATING MANAGER)
(862) 200-5454
Entity
Organization
Contact information
Practice address
1069 RINGWOOD AVE, HASKELL, NJ 07420-1408
(862) 200-5454
(862) 200-5453
Mailing address
1069 RINGWOOD AVE, HASKELL, NJ 07420-1408
(862) 200-5454
(862) 200-5453
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
27OA00509800
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
132242
MEDICARE PTAN
NJ
05
—
7757204
—
NJ
Enumeration date
05/15/2008
Last updated
10/13/2009
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