Provider Demographics
NPI:1659370575
Name:NEW JERSEY VISION ASSOCIATES PC
Entity Type:Organization
Organization Name:NEW JERSEY VISION ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:VOGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-779-0808
Mailing Address - Street 1:1455 BROAD ST STE 110
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-3039
Mailing Address - Country:US
Mailing Address - Phone:973-779-0808
Mailing Address - Fax:973-471-1929
Practice Address - Street 1:1455 BROAD ST STE 110
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-3039
Practice Address - Country:US
Practice Address - Phone:973-779-0808
Practice Address - Fax:973-471-1929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-21
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06370000207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2063375OtherAETNA ID NUMBER
656338004OtherCIGNA ID NUMBER
P1094006OtherOXFORD ID NUMBER
NJ7650809Medicaid
0499882OtherGHI ID NUMBER
1870514OtherUNITED HEALTHCARE ID
2063375OtherAETNA ID NUMBER
P1094006OtherOXFORD ID NUMBER
P1094006OtherOXFORD ID NUMBER
0K8636OtherHEALTH NET ID NUMBER
=========OtherPHCS ID NUMBER
2063375OtherAETNA ID NUMBER
=========OtherGUARDIAN ID NUMBER
=========OtherFIRST UNITED AMERICAN ID
=========OtherMULTIPLAN NETWORK ID
=========OtherREYNOLDS AND REYNOLDS
656338004OtherCIGNA ID NUMBER
=========OtherMAGNACARE ID NUMBER
NJ108508Medicare PIN