Provider Demographics
NPI:1255658712
Name:RETINA CENTER OF NEW JERSEY PA
Entity Type:Organization
Organization Name:RETINA CENTER OF NEW JERSEY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:F
Authorized Official - Last Name:KRAUSHAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-232-0909
Mailing Address - Street 1:509 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-2115
Mailing Address - Country:US
Mailing Address - Phone:908-232-0909
Mailing Address - Fax:908-232-4339
Practice Address - Street 1:509 E BROAD ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-2115
Practice Address - Country:US
Practice Address - Phone:908-232-0909
Practice Address - Fax:908-232-4339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-23
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02750700207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2966301Medicaid
046114Medicare PIN
NJ2966301Medicaid