Provider Demographics
NPI:1366482838
Name:VITREO RETINAL ASSOCIATES OF NJ PA
Entity Type:Organization
Organization Name:VITREO RETINAL ASSOCIATES OF NJ PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:CANGEMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-751-8808
Mailing Address - Street 1:36 NEWARK AVE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-4119
Mailing Address - Country:US
Mailing Address - Phone:973-751-8808
Mailing Address - Fax:973-751-3095
Practice Address - Street 1:36 NEWARK AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-4119
Practice Address - Country:US
Practice Address - Phone:973-751-8808
Practice Address - Fax:973-751-3095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2963400Medicaid
NJCF8219OtherRAILROAD MEDICARE
NJ505551Medicare ID - Type Unspecified
NJ2963400Medicaid