Provider Demographics
NPI:1467539791
Name:THE EYE CLINIC NJ
Entity Type:Organization
Organization Name:THE EYE CLINIC NJ
Other - Org Name:EYE CLINIC PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANABELA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-686-2525
Mailing Address - Street 1:1095 MORRIS AVE STE 400
Mailing Address - Street 2:LIBERTY HALL II
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083
Mailing Address - Country:US
Mailing Address - Phone:908-686-2525
Mailing Address - Fax:908-947-0630
Practice Address - Street 1:1095 MORRIS AVE STE 400
Practice Address - Street 2:LIBERTY HALL II
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083
Practice Address - Country:US
Practice Address - Phone:908-686-2525
Practice Address - Fax:908-947-0630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ142378OtherMEDICATE
NJ2697505Medicaid
NJ2697505Medicaid