Provider Demographics
NPI:1083949622
Name:HACKENSACK EYE SURGERY CENTER
Entity Type:Organization
Organization Name:HACKENSACK EYE SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPHTHALMOLOGY DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:LIVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-342-5191
Mailing Address - Street 1:391 SUMMIT AVENUE
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601
Mailing Address - Country:US
Mailing Address - Phone:201-342-5191
Mailing Address - Fax:201-487-0026
Practice Address - Street 1:391 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1414
Practice Address - Country:US
Practice Address - Phone:201-342-5191
Practice Address - Fax:201-487-0026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-15
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03541600174400000X
NJ25MA008438700174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD19450Medicare UPIN