Provider Demographics
NPI:1225283948
Name:PROMENADE EYE CARE, P.A.
Entity Type:Organization
Organization Name:PROMENADE EYE CARE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NIMISH
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:973-769-7610
Mailing Address - Street 1:2 VAN DUYNE CT
Mailing Address - Street 2:
Mailing Address - City:TOWACO
Mailing Address - State:NJ
Mailing Address - Zip Code:07082-1439
Mailing Address - Country:US
Mailing Address - Phone:973-839-0626
Mailing Address - Fax:973-839-7317
Practice Address - Street 1:550 NEWARK POMPTON TPKE
Practice Address - Street 2:
Practice Address - City:POMPTON PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07444-1729
Practice Address - Country:US
Practice Address - Phone:973-839-0626
Practice Address - Fax:973-839-7317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-21
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ5385152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU59295Medicare UPIN
NJ144833Medicare PIN