Provider Demographics
NPI:1801603907
Name:SPECIALTY EYE SURGEON INC
Entity type:Organization
Organization Name:SPECIALTY EYE SURGEON INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIETONI
Authorized Official - Middle Name:
Authorized Official - Last Name:ORDONO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-222-8700
Mailing Address - Street 1:40 UNION AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-3290
Mailing Address - Country:US
Mailing Address - Phone:908-222-8700
Mailing Address - Fax:
Practice Address - Street 1:40 UNION AVE STE 106
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-3290
Practice Address - Country:US
Practice Address - Phone:908-222-8700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty