Provider Demographics
NPI:1265749964
Name:AMESUR EYE ASSOCIATES, P.A.
Entity type:Organization
Organization Name:AMESUR EYE ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:AMESUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-857-4751
Mailing Address - Street 1:947 LINWOOD AVE
Mailing Address - Street 2:SUITE 2 SOUTH
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-2939
Mailing Address - Country:US
Mailing Address - Phone:201-857-4751
Mailing Address - Fax:201-857-4752
Practice Address - Street 1:947 LINWOOD AVE
Practice Address - Street 2:SUITE 2 SOUTH
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-2939
Practice Address - Country:US
Practice Address - Phone:201-857-4751
Practice Address - Fax:201-857-4752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-02
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07468300207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
065952OtherMEDICARE ID
065952OtherMEDICARE ID