Healthcare Provider Details

I. General information

NPI: 1154838316
Provider Name (Legal Business Name): NJ EYE AND EAR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2018
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 MAIN AVE UNIT 1
CLIFTON NJ
07011-2327
US

IV. Provider business mailing address

1016 MAIN AVE UNIT 1
CLIFTON NJ
07011-2327
US

V. Phone/Fax

Practice location:
  • Phone: 973-546-5700
  • Fax: 800-878-2811
Mailing address:
  • Phone: 973-546-5700
  • Fax: 800-878-2811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: ANITA KROL
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 973-546-5700