Provider Demographics
NPI:1326110552
Name:CENTRAL PARKWAY EYE-CARE CENTER, P.A.
Entity Type:Organization
Organization Name:CENTRAL PARKWAY EYE-CARE CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPHTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DAVIS
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-673-4620
Mailing Address - Street 1:185 CENTRAL AVE
Mailing Address - Street 2:STE 509
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-3332
Mailing Address - Country:US
Mailing Address - Phone:973-673-4620
Mailing Address - Fax:973-673-3260
Practice Address - Street 1:185 CENTRAL AVE
Practice Address - Street 2:STE 509
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-3332
Practice Address - Country:US
Practice Address - Phone:973-673-4620
Practice Address - Fax:973-673-3260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA-39692207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2643405Medicaid
NJ1004410001Medicare NSC
NJE-27666Medicare UPIN
NJ2643405Medicaid