Provider Demographics
NPI:1982690020
Name:PHILADELPHIA EYE ASSOCIATES OF SOUTH JERSEY
Entity Type:Organization
Organization Name:PHILADELPHIA EYE ASSOCIATES OF SOUTH JERSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:COLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:AKKARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-423-5154
Mailing Address - Street 1:1703 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-1536
Mailing Address - Country:US
Mailing Address - Phone:609-871-1112
Mailing Address - Fax:609-871-0002
Practice Address - Street 1:1113 HOSPITAL DR
Practice Address - Street 2:SUITE 302
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-1103
Practice Address - Country:US
Practice Address - Phone:609-871-1112
Practice Address - Fax:609-871-0002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-23
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ566533Medicare PIN