Provider Demographics
NPI:1225230261
Name:AFFILIATED EYE SURGEONS NORTHERN NEW JERSEY P A
Entity Type:Organization
Organization Name:AFFILIATED EYE SURGEONS NORTHERN NEW JERSEY P A
Other - Org Name:AFFILIATED EYE SURGEONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:FELICE
Authorized Official - Last Name:MEDFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-984-5005
Mailing Address - Street 1:95 MADISON AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-6092
Mailing Address - Country:US
Mailing Address - Phone:973-984-5005
Mailing Address - Fax:973-984-5554
Practice Address - Street 1:405 NORTHFIELD AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-3026
Practice Address - Country:US
Practice Address - Phone:973-736-3322
Practice Address - Fax:973-736-7317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ536509DGTMedicare PIN
NJC56941Medicare UPIN
NJ0817590002Medicare NSC