1255697876 NPI number — MEDICAL EYE ASSOCIATES OF MT LAUREL PC

Table of content: (NPI 1255697876)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255697876 NPI number — MEDICAL EYE ASSOCIATES OF MT LAUREL PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL EYE ASSOCIATES OF MT LAUREL 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:
1255697876
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7840 MONTGOMERY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45236-4301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-354-5808
Provider Business Mailing Address Fax Number:
513-354-5774

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
303 FELLOWSHIP RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
MOUNT LAUREL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08054-1212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-234-4590
Provider Business Practice Location Address Fax Number:
856-231-9963
Provider Enumeration Date:
04/09/2012

Additional Information

Authorized Official

Authorized Official Last Name:
SHAH
Authorized Official First Name:
CHIRAG
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
609-649-8500

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  25MA07384800 , 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)





Copyright © 2007-2025 www.npivalidator.com