Provider Demographics
NPI:1235155615
Name:NEW JERSEY EYE CENTER, P.A.
Entity Type:Organization
Organization Name:NEW JERSEY EYE CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:DELLO RUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:201-244-3177
Mailing Address - Street 1:1 NORTH WASHINGTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-2125
Mailing Address - Country:US
Mailing Address - Phone:201-384-7333
Mailing Address - Fax:201-384-9915
Practice Address - Street 1:1 NORTH WASHINGTON AVENUE
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-2125
Practice Address - Country:US
Practice Address - Phone:201-384-7333
Practice Address - Fax:201-384-9915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27TO00121200152W00000X
NJ25MA2132400207W00000X
NJ25MA07418400207W00000X
NJ25MA06472800207W00000X
NJ25MA06568400207W00000X
NJ25MA06768400207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJCM5862OtherRAILROAD MEDICARE GROUP#
NJCM5862OtherRAILROAD MEDICARE GROUP#
NJ579818Medicare PIN