1225229941 NPI number — MILLENNIUM EYE CARE, LLC

Table of content: (NPI 1225229941)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225229941 NPI number — MILLENNIUM EYE CARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MILLENNIUM EYE CARE, 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:
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:
1225229941
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 W MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREEHOLD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07728-2500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-462-8707
Provider Business Mailing Address Fax Number:
732-780-3699

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ROUTE 130 & PRINCETON RD
Provider Second Line Business Practice Location Address:
SUITE1
Provider Business Practice Location Address City Name:
HIGHTSTOWN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-448-3990
Provider Business Practice Location Address Fax Number:
609-448-4197
Provider Enumeration Date:
08/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MISHKIN
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
732-462-8707

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  25MA05082500 , 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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