Provider Demographics
NPI:1730270638
Name:LABRADA, JEANINE ELIZABETH (OD)
Entity type:Individual
Prefix:
First Name:JEANINE
Middle Name:ELIZABETH
Last Name:LABRADA
Suffix:
Gender:F
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:PO BOX 744
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-0744
Mailing Address - Country:US
Mailing Address - Phone:908-852-3900
Mailing Address - Fax:908-852-3903
Practice Address - Street 1:915 ROUTE 517 # B16
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-4661
Practice Address - Country:US
Practice Address - Phone:908-852-3900
Practice Address - Fax:908-852-3903
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOA-05422152W00000X
NJTO-000796152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU62967Medicare UPIN
NJ892879Medicare ID - Type Unspecified