Provider Demographics
NPI:1225084791
Name:GLAUCOMA INSTITUTE, PC
Entity Type:Organization
Organization Name:GLAUCOMA INSTITUTE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GLAUCOMA SPECIALIST
Authorized Official - Prefix:DR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MOBIN-UDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-546-3910
Mailing Address - Street 1:10 PLUM STREET
Mailing Address - Street 2:6TH. FLOOR SUITE 600
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901
Mailing Address - Country:US
Mailing Address - Phone:732-546-3910
Mailing Address - Fax:480-287-9735
Practice Address - Street 1:10 PLUM STREET
Practice Address - Street 2:6TH. FLOOR SUITE 600
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901
Practice Address - Country:US
Practice Address - Phone:732-546-3910
Practice Address - Fax:480-287-9735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0029505Medicaid
NJH16167Medicare UPIN
NJ0029505Medicaid