Provider Demographics
NPI:1801088562
Name:GLAUCOMA INSTITUTE OF NORTHERN NEW JERSEY LLC
Entity type:Organization
Organization Name:GLAUCOMA INSTITUTE OF NORTHERN NEW JERSEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:LAMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-343-3499
Mailing Address - Street 1:87 W PASSAIC ST
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07662-3213
Mailing Address - Country:US
Mailing Address - Phone:201-343-3499
Mailing Address - Fax:201-343-1799
Practice Address - Street 1:87 W PASSAIC ST
Practice Address - Street 2:
Practice Address - City:ROCHELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07662-3213
Practice Address - Country:US
Practice Address - Phone:201-343-3499
Practice Address - Fax:201-343-1799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-15
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06435600174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty