Provider Demographics
NPI:1972663458
Name:WINFIELD MEDICAL EYE CENTER, PA
Entity Type:Organization
Organization Name:WINFIELD MEDICAL EYE CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:WINFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-778-8439
Mailing Address - Street 1:200 GREGORY AVE
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-3802
Mailing Address - Country:US
Mailing Address - Phone:973-778-8439
Mailing Address - Fax:973-777-1143
Practice Address - Street 1:200 GREGORY AVE
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-3802
Practice Address - Country:US
Practice Address - Phone:973-778-8439
Practice Address - Fax:973-777-1143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207W00000X
NJ25MA05266300332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3768902Medicaid
NJB83163Medicare UPIN
NJ3768902Medicaid
NJ0400860001Medicare NSC