Provider Demographics
NPI:1477611911
Name:JERROLD & PRESS, M.D., P.A.
Entity Type:Organization
Organization Name:JERROLD & PRESS, M.D., P.A.
Other - Org Name:EDISON EYE GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LORIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:PRESS
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:732-494-6720
Mailing Address - Street 1:7 STATE ROUTE 27
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3965
Mailing Address - Country:US
Mailing Address - Phone:732-494-6720
Mailing Address - Fax:732-662-1818
Practice Address - Street 1:7 STATE ROUTE 27
Practice Address - Street 2:SUITE 101
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3965
Practice Address - Country:US
Practice Address - Phone:732-494-6720
Practice Address - Fax:732-662-1818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02891300207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ114756OtherAETNA
NJ114756OtherAETNA