Provider Demographics
NPI:1053445197
Name:GARDEN STATE EYE CENTER, P.A.
Entity Type:Organization
Organization Name:GARDEN STATE EYE CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOSHE
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROTHKOPF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-363-2244
Mailing Address - Street 1:1195 HIGHWAY 70
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5946
Mailing Address - Country:US
Mailing Address - Phone:732-363-2244
Mailing Address - Fax:732-363-1825
Practice Address - Street 1:1195 HIGHWAY 70
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5946
Practice Address - Country:US
Practice Address - Phone:732-363-2244
Practice Address - Fax:732-363-1825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1051964OtherAETNA
NJ3421708Medicaid
NJ=========OtherHORIZON
1051964OtherAETNA