Provider Demographics
NPI:1457442600
Name:NEW JERSEY VISION ASSSOCIATES GROUP PRACTICES PC
Entity Type:Organization
Organization Name:NEW JERSEY VISION ASSSOCIATES GROUP PRACTICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-491-2127
Mailing Address - Street 1:601 S HENDERSON RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-3596
Mailing Address - Country:US
Mailing Address - Phone:610-491-2127
Mailing Address - Fax:610-337-2133
Practice Address - Street 1:1800 CHAPEL AVE W
Practice Address - Street 2:SUITE 100
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-4602
Practice Address - Country:US
Practice Address - Phone:856-910-9987
Practice Address - Fax:610-337-2133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ094634Medicare PIN
NJ094634Medicare ID - Type Unspecified