1225171150 NPI number — EYE INSTITUTE OF CENTRAL NEW JERSEY, PC

Table of content: (NPI 1225171150)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225171150 NPI number — EYE INSTITUTE OF CENTRAL NEW JERSEY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EYE INSTITUTE OF CENTRAL NEW JERSEY, PC
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:
1225171150
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1130 RARITAN RD STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRANFORD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07016-3378
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-325-6227
Provider Business Mailing Address Fax Number:
908-325-3306

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1130 RARITAN RD STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRANFORD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07016-3378
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-325-6227
Provider Business Practice Location Address Fax Number:
908-325-3306
Provider Enumeration Date:
02/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
AIELLO
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
CONRAD
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
973-632-0323

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  25MA07826300 , 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: 0101371 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 22-3842822 . This is a "MAGNACARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 527B1 . This is a "WELL CHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 22-3842822 . This is a "QUALCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0400968 . This is a "GHI" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1311820 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2678988000 . This is a "AMERIHEALTH NJ" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 5796125 . This is a "AETNA PPO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 22-3842822 . This is a "HORIZON BLUE CROSS NJ" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P3663640 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1247000 . This is a "AETNA HMO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 6241886 . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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