1982751939 NPI number — MANAHAWKIN VISION INC.

Table of content: (NPI 1982751939)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982751939 NPI number — MANAHAWKIN VISION INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MANAHAWKIN VISION INC.
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:
1982751939
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
733 ROUTE 72 W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANAHAWKIN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08050-2839
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-597-0250
Provider Business Mailing Address Fax Number:
609-597-0252

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
733 ROUTE 72 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANAHAWKIN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08050-2839
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-597-0250
Provider Business Practice Location Address Fax Number:
609-597-0252
Provider Enumeration Date:
01/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MCGLAUGHLIN
Authorized Official First Name:
DARLEEN
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
609-597-0250

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  27OA00427900 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 27OA00426400 , 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: K16299 . This is a "DR. SHISSIAS HEALTHNET ID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2533201 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6952208 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: NJ4264 . This is a "EYEMED GROUP NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 4501820 . This is a "DR. MELTZER AETNA ID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: NJ04264 . This is a "VBA GROUP NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: EYEF01296 . This is a "SPECTERA GROUP NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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