Provider Demographics
NPI:1629023551
Name:ATLANTIC EYE PHYSICIANS, PA
Entity Type:Organization
Organization Name:ATLANTIC EYE PHYSICIANS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING/BILLING
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:JUETTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-222-7373
Mailing Address - Street 1:300 HIGHWAY 35
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-2216
Mailing Address - Country:US
Mailing Address - Phone:732-222-7373
Mailing Address - Fax:732-483-8412
Practice Address - Street 1:300 HIGHWAY 35 # 204
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-2216
Practice Address - Country:US
Practice Address - Phone:732-222-7373
Practice Address - Fax:732-483-8214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ035385Medicare PIN
NJ0361460001Medicare NSC