Provider Demographics
NPI:1336346618
Name:NEW JERSEY REFRACTIVE PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:NEW JERSEY REFRACTIVE PROFESSIONAL CORPORATION
Other - Org Name:DIAMOND VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMERSON
Authorized Official - Middle Name:
Authorized Official - Last Name:QUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-869-2255
Mailing Address - Street 1:41 W PUTNAM AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-5300
Mailing Address - Country:US
Mailing Address - Phone:203-869-2255
Mailing Address - Fax:203-869-0333
Practice Address - Street 1:1 KALISA WAY
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-3516
Practice Address - Country:US
Practice Address - Phone:800-984-2020
Practice Address - Fax:203-869-0333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty