Provider Demographics
NPI:1427397710
Name:AFFILIATED EYE SURGEONS NORTHERN NEW JERSEY P A
Entity Type:Organization
Organization Name:AFFILIATED EYE SURGEONS NORTHERN NEW JERSEY P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-984-5005
Mailing Address - Street 1:95 MADISON AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-6092
Mailing Address - Country:US
Mailing Address - Phone:973-984-5005
Mailing Address - Fax:973-984-5554
Practice Address - Street 1:16 POCONO RD
Practice Address - Street 2:SUITE 204
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2901
Practice Address - Country:US
Practice Address - Phone:973-625-3363
Practice Address - Fax:973-586-6824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04685200207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty