Provider Demographics
NPI:1538249180
Name:JANKOLOVITS, MELVIN (OD)
Entity type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:
Last Name:JANKOLOVITS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-3405
Mailing Address - Country:US
Mailing Address - Phone:201-348-0800
Mailing Address - Fax:201-348-0801
Practice Address - Street 1:149 FRONT ST
Practice Address - Street 2:
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094-3405
Practice Address - Country:US
Practice Address - Phone:201-348-0800
Practice Address - Fax:201-348-0801
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3835152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJV26930Medicare UPIN
NJ521633Medicare ID - Type Unspecified