Provider Demographics
NPI:1457305591
Name:NORTHERN NEW JERSEY EYE INSTITUTE, PA
Entity Type:Organization
Organization Name:NORTHERN NEW JERSEY EYE INSTITUTE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:SPIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-763-2203
Mailing Address - Street 1:71 SECOND ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-1855
Mailing Address - Country:US
Mailing Address - Phone:973-763-2203
Mailing Address - Fax:973-762-9449
Practice Address - Street 1:71 2ND ST
Practice Address - Street 2:
Practice Address - City:SOUTH ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079-1855
Practice Address - Country:US
Practice Address - Phone:973-763-2203
Practice Address - Fax:973-762-9449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3129306Medicaid
NJ3129306Medicaid