Healthcare Provider Details

I. General information

NPI: 1780431684
Provider Name (Legal Business Name): NEW JERSEY OCULOPLASTIC SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2024
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 RIDGE ST
BASKING RIDGE NJ
07920-1785
US

IV. Provider business mailing address

150 W 58TH ST APT 1C
NEW YORK NY
10019-2116
US

V. Phone/Fax

Practice location:
  • Phone: 212-484-9707
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES CHELNIS
Title or Position: PHYSICIAN
Credential: MD
Phone: 212-484-9707