1427397710 NPI number — AFFILIATED EYE SURGEONS NORTHERN NEW JERSEY P A

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 1427397710 NPI number — AFFILIATED EYE SURGEONS NORTHERN NEW JERSEY P A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AFFILIATED EYE SURGEONS NORTHERN NEW JERSEY P A
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:
1427397710
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
95 MADISON AVE
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
MORRISTOWN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07960-6092
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-984-5005
Provider Business Mailing Address Fax Number:
973-984-5554

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16 POCONO RD
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
DENVILLE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07834-2901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-625-3363
Provider Business Practice Location Address Fax Number:
973-586-6824
Provider Enumeration Date:
02/06/2013

Additional Information

Authorized Official

Authorized Official Last Name:
MEDFORD
Authorized Official First Name:
NANCY
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
973-984-5005

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  25MA04685200 , 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)





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