1952382871 NPI number — SANTAMARIA EYE CENTER P A

Table of content: (NPI 1952382871)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952382871 NPI number — SANTAMARIA EYE CENTER P A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANTAMARIA EYE CENTER 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:
1952382871
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
104 MARKET ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PERTH AMBOY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08861-4412
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-826-5159
Provider Business Mailing Address Fax Number:
732-826-2107

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
104 MARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PERTH AMBOY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08861-4412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-826-5159
Provider Business Practice Location Address Fax Number:
732-826-2107
Provider Enumeration Date:
11/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DISLA
Authorized Official First Name:
MENCIA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
732-826-5159

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  MA034125 , 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: 8940703 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: OK7192 . This is a "HEALTHNET OF NJ" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0074584000 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 27003 . This is a "UNIVERSITY HEALTH PLAN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1093155 . This is a "HORIZON NJ HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 352731 . This is a "MEDICARE OF NY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: LS342 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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