Provider Demographics
NPI:1851471379
Name:PHILLIPS EYE CENTER PA
Entity Type:Organization
Organization Name:PHILLIPS EYE CENTER PA
Other - Org Name:HUDSON EYE SPECIALISTS
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ATTENELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-796-3330
Mailing Address - Street 1:619 RIVER DRIVE
Mailing Address - Street 2:CENTER ONE, SECOND FLOOR
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07407
Mailing Address - Country:US
Mailing Address - Phone:201-796-2020
Mailing Address - Fax:201-796-2833
Practice Address - Street 1:619 RIVER DRIVE
Practice Address - Street 2:CENTER ONE, SECOND FLOOR
Practice Address - City:ELMWOOD PARK
Practice Address - State:NJ
Practice Address - Zip Code:07407
Practice Address - Country:US
Practice Address - Phone:201-796-2020
Practice Address - Fax:201-796-2833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7265107Medicaid
NJ=========OtherTAX ID
NJ613854Medicare ID - Type Unspecified