Provider Demographics
NPI:1952344707
Name:OCEAN COUNTY RETINA PC
Entity Type:Organization
Organization Name:OCEAN COUNTY RETINA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARIS
Authorized Official - Middle Name:IRFAN
Authorized Official - Last Name:AMIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-797-1855
Mailing Address - Street 1:780 ROUTE 37 W
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-5059
Mailing Address - Country:US
Mailing Address - Phone:732-797-1855
Mailing Address - Fax:732-797-1856
Practice Address - Street 1:780 ROUTE 37 W
Practice Address - Street 2:SUITE 200
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-5059
Practice Address - Country:US
Practice Address - Phone:732-797-1855
Practice Address - Fax:732-797-1856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07562000207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJDA5557OtherMEDICARE RAILROAD
NJ0031232Medicaid
NJ0031232Medicaid
G64461Medicare UPIN