Provider Demographics
NPI:1336138635
Name:EYE SURGICAL SPECIALISTS OF NEW JERSEY
Entity Type:Organization
Organization Name:EYE SURGICAL SPECIALISTS OF NEW JERSEY
Other - Org Name:SURGERY CENTER OF CENTRAL NEW JERSEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:Y
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-297-8001
Mailing Address - Street 1:107 N CENTER DR
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-4909
Mailing Address - Country:US
Mailing Address - Phone:732-297-8001
Mailing Address - Fax:732-297-8007
Practice Address - Street 1:107 N CENTER DR
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-4909
Practice Address - Country:US
Practice Address - Phone:732-297-8001
Practice Address - Fax:732-297-8007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22288261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7679904Medicaid
NJ300839Medicare ID - Type Unspecified