Provider Demographics
NPI:1598236523
Name:RIDGEDALE EYE ASSOCIATES
Entity Type:Organization
Organization Name:RIDGEDALE EYE ASSOCIATES
Other - Org Name:RIDGEDALE FAMILY EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:FRUCHTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:973-301-0400
Mailing Address - Street 1:256 COLUMBIA TPKE STE 211
Mailing Address - Street 2:
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-1231
Mailing Address - Country:US
Mailing Address - Phone:973-301-0400
Mailing Address - Fax:
Practice Address - Street 1:256 COLUMBIA TPKE STE 211
Practice Address - Street 2:
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1231
Practice Address - Country:US
Practice Address - Phone:973-301-0400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-17
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty