Provider Demographics
NPI:1891977351
Name:MORGENSTERN CENTER FOR ORBITAL AND FACIAL PLASTIC SURGERY OF NJ LLC
Entity Type:Organization
Organization Name:MORGENSTERN CENTER FOR ORBITAL AND FACIAL PLASTIC SURGERY OF NJ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:ELI
Authorized Official - Last Name:MORGENSTERN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-687-8771
Mailing Address - Street 1:123 BLOOMINGDALE AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-4056
Mailing Address - Country:US
Mailing Address - Phone:610-687-8771
Mailing Address - Fax:610-687-8773
Practice Address - Street 1:2835 S DELSEA DR
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-7056
Practice Address - Country:US
Practice Address - Phone:610-687-8771
Practice Address - Fax:610-687-8773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207W00000X, 207WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive SurgeryGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ122537Medicare PIN
NJ122537Medicare PIN