Individual provider Active NPI

Mansoor Syed, O.D.

  • Optometrist
  • Woodbridge, NJ
National Provider Identifier
1477781763
Registry record updated Jun 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
27OA00619200 Issued in NJ
Practice address
360 US Highway 9 N
Woodbridge, NJ 07095-1004
Phone
(732) 826-6932
Fax
(732) 826-6936
NPI assigned
Jun 25, 2009
Last updated
Jun 13, 2012By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 13, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X TUV007432-1 NY
Optometrist 152W00000X 27OA00619200 NJ Primary

Addresses

Primary practice location

360 US Highway 9 N
Woodbridge, NJ 07095-1004

Mailing address

105 Shelley Ave
Staten Island, NY 10314-4719
Phone (917) 355-4884

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240216000456 NY Practitioner - Optometry 8224280052 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
27OA00619200NJMDOptometrist
TUV007432-1NYMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Sol Optical LLC Optometrist CurrentSince Nov 20, 2023 Accepting new patients

Locations

4410 18th Ave
Brooklyn, NY 11204
Phone (718) 853-7203

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1245888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1339545600000",
    "number": "1477781763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 SHELLEY AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103144719",
            "telephone_number": "917-355-4884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 US HIGHWAY 9 N",
            "city": "WOODBRIDGE",
            "state": "NJ",
            "postal_code": "070951004",
            "telephone_number": "732-826-6932",
            "fax_number": "732-826-6936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SYED",
        "first_name": "MANSOOR",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-06-25",
        "last_updated": "2012-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "TUV007432-1",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NJ",
            "license": "27OA00619200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbridge, NJ

Sources for this page

Verify at the official NPI Registry.