Provider Demographics
NPI:1598073306
Name:CALVARY MEDICAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:CALVARY MEDICAL ASSOCIATES LLC
Other - Org Name:VALLEY SPRING EYECARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-762-4996
Mailing Address - Street 1:2040 MILLBURN AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-3726
Mailing Address - Country:US
Mailing Address - Phone:973-762-4996
Mailing Address - Fax:973-762-4955
Practice Address - Street 1:2040 MILLBURN AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-3726
Practice Address - Country:US
Practice Address - Phone:973-762-4996
Practice Address - Fax:973-762-4955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05142400207R00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty