Provider Demographics
NPI:1275818197
Name:PEDIATRIC EYECARE OF NORTHERN JERSEY, P.C.
Entity Type:Organization
Organization Name:PEDIATRIC EYECARE OF NORTHERN JERSEY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUNNY
Authorized Official - Middle Name:
Authorized Official - Last Name:SONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-541-6806
Mailing Address - Street 1:401A S VAN BRUNT ST
Mailing Address - Street 2:STE. 200
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4600
Mailing Address - Country:US
Mailing Address - Phone:201-541-6806
Mailing Address - Fax:201-541-6807
Practice Address - Street 1:401A S VAN BRUNT ST
Practice Address - Street 2:STE. 200
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4600
Practice Address - Country:US
Practice Address - Phone:201-541-6806
Practice Address - Fax:201-541-6807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-12
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08681500174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty