1548202948 NPI number — NEW JERSEY REGIONAL EYE CARE, PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548202948 NPI number — NEW JERSEY REGIONAL EYE CARE, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW JERSEY REGIONAL EYE CARE, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548202948
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
284 N FRANKLIN TPKE
Provider Second Line Business Mailing Address:
2ND FLOOR
Provider Business Mailing Address City Name:
RAMSEY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07446-1629
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-327-3006
Provider Business Mailing Address Fax Number:
201-327-0720

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
284 N FRANKLIN TPKE
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
RAMSEY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07446-1629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-327-3006
Provider Business Practice Location Address Fax Number:
201-327-0720
Provider Enumeration Date:
06/11/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VAN INWEGEN
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
RICHARD
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
201-327-3006

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  27OA00583100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 27OA00638500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: MA63643 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)