Provider Demographics
NPI:1013092071
Name:SPECIALTY MD INC
Entity Type:Organization
Organization Name:SPECIALTY MD INC
Other - Org Name:HEALTH CHECK EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ZENITH
Authorized Official - Middle Name:
Authorized Official - Last Name:YLANAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:908-222-3506
Mailing Address - Street 1:1308 CENTENNIAL AVE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854
Mailing Address - Country:US
Mailing Address - Phone:908-222-3506
Mailing Address - Fax:908-222-8770
Practice Address - Street 1:906 OAK TREE AVE
Practice Address - Street 2:SUITE J
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-5127
Practice Address - Country:US
Practice Address - Phone:908-222-3506
Practice Address - Fax:908-222-8770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0083658Medicaid
NJ1013092071OtherNPI
NJ0007277772OtherPIN
NJ0083658Medicaid
NJ096386Medicare ID - Type Unspecified