Provider Demographics
NPI:1376536417
Name:BERGEN-PASSAIC CATARACT LASER AND SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:BERGEN-PASSAIC CATARACT LASER AND SURGERY CENTER, LLC
Other - Org Name:BERGEN-PASSAIC EYE SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:I
Authorized Official - Last Name:HAUSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-414-5649
Mailing Address - Street 1:18-01 POLLITT DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-2813
Mailing Address - Country:US
Mailing Address - Phone:201-414-5649
Mailing Address - Fax:201-398-9132
Practice Address - Street 1:18-01 POLLITT DR
Practice Address - Street 2:SUITE 4
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-2813
Practice Address - Country:US
Practice Address - Phone:201-414-5649
Practice Address - Fax:201-398-9132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2017-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJANC847OtherOXFORD INS
NJ0001457000OtherAMERIHEALTH
490001083OtherRAILROAD MEDICARE
NJ311023OtherHORIZON BC BS OF NJ
NJ7465301Medicaid
NJ91000613500OtherAMERICHOICE
NJ0074894OtherAETNA INS
NJNK9611OtherHEALTHNET
NJ7465301Medicaid