Provider Demographics
NPI:1649324377
Name:PASCACK VALLEY OPHTHALMOLOGY ASSOC PA
Entity type:Organization
Organization Name:PASCACK VALLEY OPHTHALMOLOGY ASSOC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OPHTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STEINBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-664-8989
Mailing Address - Street 1:400 OLD HOOK RD
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-2732
Mailing Address - Country:US
Mailing Address - Phone:201-664-8989
Mailing Address - Fax:201-664-5106
Practice Address - Street 1:400 OLD HOOK RD
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-2732
Practice Address - Country:US
Practice Address - Phone:201-664-8989
Practice Address - Fax:201-664-5106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02359100207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2894602Medicaid
057556Medicare ID - Type Unspecified
C61632Medicare UPIN
NJ0303910001Medicare NSC