Provider Demographics
NPI:1326087156
Name:RETINA VITREAUS CENTER
Entity Type:Organization
Organization Name:RETINA VITREAUS CENTER
Other - Org Name:ASSOCIATED RETINA CONSULTANTS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:LUDWIG
Authorized Official - Suffix:III
Authorized Official - Credentials:FACMPE
Authorized Official - Phone:732-568-1246
Mailing Address - Street 1:1700 GALLOPING HILL RD
Mailing Address - Street 2:
Mailing Address - City:KENILWORTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07033-1303
Mailing Address - Country:US
Mailing Address - Phone:908-488-8333
Mailing Address - Fax:908-458-8339
Practice Address - Street 1:1700 GALLOPING HILL RD
Practice Address - Street 2:
Practice Address - City:KENILWORTH
Practice Address - State:NJ
Practice Address - Zip Code:07033-1303
Practice Address - Country:US
Practice Address - Phone:908-488-8333
Practice Address - Fax:908-458-8339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ896447Medicare PIN
NJ427276Medicare PIN