Provider Demographics
NPI:1720193733
Name:PAUL PHILLIPS EYE & SURGERY CENTER PC
Entity Type:Organization
Organization Name:PAUL PHILLIPS EYE & SURGERY CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHETLICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-824-7144
Mailing Address - Street 1:6B MINNEAKONING RD
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-5760
Mailing Address - Country:US
Mailing Address - Phone:908-824-7144
Mailing Address - Fax:908-237-0243
Practice Address - Street 1:6B MINNEAKONING RD
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-5760
Practice Address - Country:US
Practice Address - Phone:908-824-7144
Practice Address - Fax:908-237-0243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF16430Medicare UPIN
NJ5944580001Medicare NSC