Provider Demographics
NPI:1942402011
Name:CLIFFSIDE EYE CENTER L L C
Entity Type:Organization
Organization Name:CLIFFSIDE EYE CENTER L L C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-941-9400
Mailing Address - Street 1:663 PALISADE AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-3012
Mailing Address - Country:US
Mailing Address - Phone:201-941-9400
Mailing Address - Fax:201-941-5840
Practice Address - Street 1:663 PALISADE AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010-3012
Practice Address - Country:US
Practice Address - Phone:201-941-9400
Practice Address - Fax:201-941-5840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05042700207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherTAX ID