Provider Demographics
NPI:1639476310
Name:NJ EYE CARE ASSOCIATES, PA
Entity Type:Organization
Organization Name:NJ EYE CARE ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASST.
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:D
Authorized Official - Last Name:CABRALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-687-0330
Mailing Address - Street 1:155 MORRIS AVE
Mailing Address - Street 2:3RD FLOOR, SUITE 2
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-1225
Mailing Address - Country:US
Mailing Address - Phone:973-232-6900
Mailing Address - Fax:973-232-6911
Practice Address - Street 1:155 MORRIS AVE
Practice Address - Street 2:3RD FLOOR, SUITE 2
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-1225
Practice Address - Country:US
Practice Address - Phone:973-232-6900
Practice Address - Fax:973-232-6911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-16
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OM00051600152W00000X
NJ27OM00090700152W00000X
NJ27OM00089400152W00000X
NJ25MA05390500207W00000X
NJ25MA07525600207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ204179Medicare PIN