Provider Demographics
NPI:1346293735
Name:ROXBURY EYE CENTER PC
Entity Type:Organization
Organization Name:ROXBURY EYE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:PINKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-584-4451
Mailing Address - Street 1:66 SUNSET STRIP
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SUCCASUNNA
Mailing Address - State:NJ
Mailing Address - Zip Code:07876-1345
Mailing Address - Country:US
Mailing Address - Phone:973-584-4451
Mailing Address - Fax:973-584-2099
Practice Address - Street 1:66 SUNSET STRIP
Practice Address - Street 2:SUITE 107
Practice Address - City:SUCCASUNNA
Practice Address - State:NJ
Practice Address - Zip Code:07876-1345
Practice Address - Country:US
Practice Address - Phone:973-584-4451
Practice Address - Fax:973-584-2099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA05160800174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4705106Medicaid
NJ5654505Medicaid
NJ0661007Medicaid
NJE13222Medicare UPIN
NJF29463Medicare UPIN
NJ5654505Medicaid
NJ0661007Medicaid