Provider Demographics
NPI:1629287032
Name:SOUTH JERSEY EYE PHYSICIANS PA
Entity Type:Organization
Organization Name:SOUTH JERSEY EYE PHYSICIANS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:G
Authorized Official - Last Name:NACHBAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-234-0258
Mailing Address - Street 1:509 S LENOLA RD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-1561
Mailing Address - Country:US
Mailing Address - Phone:856-234-0258
Mailing Address - Fax:856-727-9518
Practice Address - Street 1:103 OLD MARLTON PIKE STE 216
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-8772
Practice Address - Country:US
Practice Address - Phone:609-714-8761
Practice Address - Fax:609-714-8759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04135500332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0599300001OtherDMERC SUPPLIER NUMBER
NJ0599300001Medicare NSC