1376536417 NPI number — BERGEN-PASSAIC CATARACT LASER AND SURGERY CENTER, LLC

Table of content: (NPI 1376536417)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376536417 NPI number — BERGEN-PASSAIC CATARACT LASER AND SURGERY CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BERGEN-PASSAIC CATARACT LASER AND SURGERY CENTER, LLC
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:
BERGEN-PASSAIC EYE SURGERY CENTER
Provider Other Organization Name Type Code:
3
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:
1376536417
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/05/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18-01 POLLITT DR
Provider Second Line Business Mailing Address:
SUITE 4
Provider Business Mailing Address City Name:
FAIR LAWN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07410-2813
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-414-5649
Provider Business Mailing Address Fax Number:
201-398-9132

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18-01 POLLITT DR
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
FAIR LAWN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07410-2813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-414-5649
Provider Business Practice Location Address Fax Number:
201-398-9132
Provider Enumeration Date:
08/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HAUSER
Authorized Official First Name:
CAROLINE
Authorized Official Middle Name:
I
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
201-414-5649

Provider Taxonomy Codes

  • Taxonomy code: 261QS0132X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: ANC847 . This is a "OXFORD INS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0001457000 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 490001083 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 311023 . This is a "HORIZON BC BS OF NJ" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 7465301 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 91000613500 . This is a "AMERICHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0074894 . This is a "AETNA INS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: NK9611 . This is a "HEALTHNET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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