Provider Demographics
NPI:1134832827
Name:RETINA MACULA INSTITUTE, PLLC
Entity type:Organization
Organization Name:RETINA MACULA INSTITUTE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:T
Authorized Official - Last Name:NEZGODA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-420-5052
Mailing Address - Street 1:736 IBIS WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408
Mailing Address - Country:US
Mailing Address - Phone:908-420-5052
Mailing Address - Fax:
Practice Address - Street 1:840 US-1
Practice Address - Street 2:SUITE 430
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408
Practice Address - Country:US
Practice Address - Phone:561-684-4773
Practice Address - Fax:561-684-9526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-28
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty