Provider Demographics
NPI:1023072824
Name:SOUTH JERSEY EYE PHYSICIANS, LLC
Entity type:Organization
Organization Name:SOUTH JERSEY EYE PHYSICIANS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP ASC OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGNIFICO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:201-216-1700
Mailing Address - Street 1:420 MOUNTAIN AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:NEW PROVIDENCE
Mailing Address - State:NJ
Mailing Address - Zip Code:07974-2736
Mailing Address - Country:US
Mailing Address - Phone:908-458-8333
Mailing Address - Fax:
Practice Address - Street 1:509 S LENOLA RD
Practice Address - Street 2:SUITE 11B
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-1561
Practice Address - Country:US
Practice Address - Phone:856-234-0222
Practice Address - Fax:856-727-9518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ490002841OtherRAILROAD MEDICARE
NJ3277305Medicaid
NJ311069Medicare PIN