Provider Demographics
NPI:1952382871
Name:SANTAMARIA EYE CENTER P A
Entity Type:Organization
Organization Name:SANTAMARIA EYE CENTER P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:MENCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DISLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-826-5159
Mailing Address - Street 1:104 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:PERTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08861-4412
Mailing Address - Country:US
Mailing Address - Phone:732-826-5159
Mailing Address - Fax:732-826-2107
Practice Address - Street 1:104 MARKET ST
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-4412
Practice Address - Country:US
Practice Address - Phone:732-826-5159
Practice Address - Fax:732-826-2107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-08
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA034125207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8940703Medicaid
NJOK7192OtherHEALTHNET OF NJ
NJ0074584000OtherAMERIHEALTH
NJ27003OtherUNIVERSITY HEALTH PLAN
NJ1093155OtherHORIZON NJ HEALTH
NY352731OtherMEDICARE OF NY
NJLS342OtherOXFORD
NJLS342OtherOXFORD
NJ1235010001Medicare NSC