Provider Demographics
NPI:1164596722
Name:ADVANCED OPTHALMOLOGY CENTER PA
Entity Type:Organization
Organization Name:ADVANCED OPTHALMOLOGY CENTER PA
Other - Org Name:MIDDLESEX OPTHALMOLOGY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MD PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHANZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-548-0700
Mailing Address - Street 1:1812 OAK TREE RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820
Mailing Address - Country:US
Mailing Address - Phone:732-548-0700
Mailing Address - Fax:732-494-5059
Practice Address - Street 1:1812 OAK TREE RD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820
Practice Address - Country:US
Practice Address - Phone:732-548-0700
Practice Address - Fax:732-494-5059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherTAX ID NUMBER
NJ3993080001Medicare NSC
NJG35729Medicare UPIN