1023072824 NPI number — SOUTH JERSEY EYE PHYSICIANS, LLC

Table of content: (NPI 1023072824)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023072824 NPI number — SOUTH JERSEY EYE PHYSICIANS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH JERSEY EYE PHYSICIANS, 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:
Provider Other Organization Name Type Code:
6
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:
1023072824
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/21/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
420 MOUNTAIN AVE FL 4
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW PROVIDENCE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07974-2736
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-458-8333
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
509 S LENOLA RD
Provider Second Line Business Practice Location Address:
SUITE 11B
Provider Business Practice Location Address City Name:
MOORESTOWN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08057-1561
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-234-0222
Provider Business Practice Location Address Fax Number:
856-727-9518
Provider Enumeration Date:
04/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MAGNIFICO
Authorized Official First Name:
LAUREN
Authorized Official Middle Name:
Authorized Official Title or Position:
VP ASC OPERATIONS
Authorized Official Telephone Number:
201-216-1700

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 490002841 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 3277305 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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