Healthcare Provider Details

I. General information

NPI: 1881640563
Provider Name (Legal Business Name): ESSEX EYE SURGERY & LASER CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 BROAD ST
BLOOMFIELD NJ
07003-3014
US

IV. Provider business mailing address

1460 BROAD ST
BLOOMFIELD NJ
07003-3014
US

V. Phone/Fax

Practice location:
  • Phone: 973-338-5566
  • Fax: 973-338-0753
Mailing address:
  • Phone: 973-338-5566
  • Fax: 973-338-0753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier311031
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerHORIZON BC ID NUMBER
# 2
Identifier7411405
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name: LOUIS SHEFFLER
Title or Position: ADMINISTRATOR
Credential:
Phone: 973-338-5566