Provider Demographics
NPI:1689865321
Name:MILLENNIUM EYE CARE,LLC
Entity Type:Organization
Organization Name:MILLENNIUM EYE CARE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MISHKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-462-8707
Mailing Address - Street 1:500 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2500
Mailing Address - Country:US
Mailing Address - Phone:732-462-8707
Mailing Address - Fax:732-780-3699
Practice Address - Street 1:2080 W COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-2009
Practice Address - Country:US
Practice Address - Phone:732-364-5123
Practice Address - Fax:732-364-3865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05082500207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1261130007Medicare NSC