1497798763 NPI number — GUBMAN EYE ASSOCIATES, PA

Table of content: (NPI 1497798763)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497798763 NPI number — GUBMAN EYE ASSOCIATES, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GUBMAN EYE ASSOCIATES, 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:
EYE AND SIGHT 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:
1497798763
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
303 SHEPPARD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VOORHEES
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08043-4670
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-751-0220
Provider Business Mailing Address Fax Number:
856-751-0222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 SHEPPARD RD
Provider Second Line Business Practice Location Address:
STE 303
Provider Business Practice Location Address City Name:
VOORHEES
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08043-4787
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-751-0220
Provider Business Practice Location Address Fax Number:
856-751-0222
Provider Enumeration Date:
06/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GUBMAN
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
856-751-0220

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OA0005166 , 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)

  • Identifier: 5300100 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5500480004 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 501029 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0759379000 . This is a "AMERIHEALTH" identifier . This identifiers is of the category "OTHER".




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