Provider Demographics
NPI:1629272232
Name:BERKELEY HEIGHTS EYE GROUP, PA
Entity Type:Organization
Organization Name:BERKELEY HEIGHTS EYE GROUP, PA
Other - Org Name:SUMMIT EYE GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:OWEN
Authorized Official - Last Name:LEVENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-464-4600
Mailing Address - Street 1:571 CENTRAL AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:NEW PROVIDENCE
Mailing Address - State:NJ
Mailing Address - Zip Code:07974-1547
Mailing Address - Country:US
Mailing Address - Phone:908-464-4600
Mailing Address - Fax:908-464-4737
Practice Address - Street 1:571 CENTRAL AVE STE 101
Practice Address - Street 2:
Practice Address - City:NEW PROVIDENCE
Practice Address - State:NJ
Practice Address - Zip Code:07974-1547
Practice Address - Country:US
Practice Address - Phone:908-464-4600
Practice Address - Fax:908-464-4737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06696300207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ114216Medicare ID - Type UnspecifiedMEDICARE ID # (MIN)