Provider Demographics
NPI:1154485464
Name:LIVINGSTON VITREO RETINAL ASSOCIATES, PA
Entity Type:Organization
Organization Name:LIVINGSTON VITREO RETINAL ASSOCIATES, PA
Other - Org Name:RETINA VITREOUS CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SAYLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-716-0123
Mailing Address - Street 1:349 E NORTHFIELD RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-4802
Mailing Address - Country:US
Mailing Address - Phone:973-716-0123
Mailing Address - Fax:973-716-0441
Practice Address - Street 1:349 E NORTHFIELD RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-4802
Practice Address - Country:US
Practice Address - Phone:973-716-0123
Practice Address - Fax:973-716-0441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05282200207W00000X, 207W00000X
NJ25MA06232200207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ804900OtherDR. XIA'S MCR NUMBER
NJ033789Medicaid
NJ578102Medicare UPIN
NJF86634Medicare UPIN
NJ578102Medicare ID - Type UnspecifiedGROUP MCR NUMBER
NJ469350Medicare ID - Type UnspecifiedDR. COHEN'S MCR NUMBER