Provider Demographics
NPI:1780653600
Name:NORTHERN OPHTHALMIC ASSOCIATES
Entity Type:Organization
Organization Name:NORTHERN OPHTHALMIC ASSOCIATES
Other - Org Name:NORTHERN OPHTHALMIC ASSOCIATES INC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/ PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:PIZZANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-885-6830
Mailing Address - Street 1:500 YORK RD STE 102
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-2871
Mailing Address - Country:US
Mailing Address - Phone:215-885-6830
Mailing Address - Fax:215-885-2433
Practice Address - Street 1:500 YORK RD STE 102
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-2871
Practice Address - Country:US
Practice Address - Phone:215-885-6830
Practice Address - Fax:215-885-2433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2021-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X, 207W00000X
PAMD045344E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1159581Medicaid
PA108829OtherMEDICARE PROVIDER NUMBER
PA108829OtherMEDICARE PROVIDER NUMBER