Provider Demographics
NPI:1851576441
Name:PEDIATRIC EYE CARE OF MONMOUTH,LLC
Entity Type:Organization
Organization Name:PEDIATRIC EYE CARE OF MONMOUTH,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARYN
Authorized Official - Middle Name:SORKIN
Authorized Official - Last Name:PEARLSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-217-3503
Mailing Address - Street 1:33 VILLAGE CT
Mailing Address - Street 2:
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730-1534
Mailing Address - Country:US
Mailing Address - Phone:732-217-3503
Mailing Address - Fax:732-217-3504
Practice Address - Street 1:33 VILLAGE CT
Practice Address - Street 2:
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1534
Practice Address - Country:US
Practice Address - Phone:732-217-3503
Practice Address - Fax:732-217-3504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA060399261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE95841Medicare UPIN