1316901978 NPI number — NEVYAS EYE ASSOCIATES OF NJ PC

Table of content: (NPI 1316901978)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316901978 NPI number — NEVYAS EYE ASSOCIATES OF NJ PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEVYAS EYE ASSOCIATES OF NJ PC
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:
1316901978
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
333 E CITY AVE
Provider Second Line Business Mailing Address:
2 BALA PLAZA
Provider Business Mailing Address City Name:
BALA CYNWYD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19004-1501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-668-2777
Provider Business Mailing Address Fax Number:
610-668-0536

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 LINCOLN DR W
Provider Second Line Business Practice Location Address:
GREENTREE EXECUTIVE CAMPUS
Provider Business Practice Location Address City Name:
MARLTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08053-1534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-985-9797
Provider Business Practice Location Address Fax Number:
856-985-1191
Provider Enumeration Date:
04/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NEVYAS
Authorized Official First Name:
HERBERT
Authorized Official Middle Name:
J
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
610-668-2777

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 763317 . This is a "PA BLUE SHIELD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0005942232 . This is a "AETNA PPO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0706610000 . This is a "AMERIHEALTH HMO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 483852 . This is a "AETNA HMO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 6619509 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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