Provider Demographics
NPI:1457369738
Name:RETINA ASSOCIATES OF NEW JERSEY PA
Entity Type:Organization
Organization Name:RETINA ASSOCIATES OF NEW JERSEY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-458-8333
Mailing Address - Street 1:1700 GALLOPING HILL RD
Mailing Address - Street 2:
Mailing Address - City:KENILWORTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07033-1303
Mailing Address - Country:US
Mailing Address - Phone:908-458-8333
Mailing Address - Fax:908-458-8339
Practice Address - Street 1:1700 GALLOPING HILL RD
Practice Address - Street 2:
Practice Address - City:KENILWORTH
Practice Address - State:NJ
Practice Address - Zip Code:07033
Practice Address - Country:US
Practice Address - Phone:908-458-8333
Practice Address - Fax:908-458-8339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ468520Medicare PIN