Provider Demographics
NPI:1013003383
Name:ADVANCED EYE CARE OF NEW JERSEY PA
Entity Type:Organization
Organization Name:ADVANCED EYE CARE OF NEW JERSEY PA
Other - Org Name:THE EYE CARE AND SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-789-8999
Mailing Address - Street 1:592 SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-1002
Mailing Address - Country:US
Mailing Address - Phone:908-789-8999
Mailing Address - Fax:908-789-1379
Practice Address - Street 1:592 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-1002
Practice Address - Country:US
Practice Address - Phone:908-789-8999
Practice Address - Fax:908-789-1379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7299206-01Medicaid
NJCD7169OtherRAILROAD MEDICARE
NJ7299206-01Medicaid
NJ0961370001Medicare NSC
NJ744207Medicare ID - Type Unspecified