Healthcare Provider Details

I. General information

NPI: 1427397710
Provider Name (Legal Business Name): AFFILIATED EYE SURGEONS NORTHERN NEW JERSEY P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2013
Last Update Date: 02/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 POCONO RD SUITE 204
DENVILLE NJ
07834-2901
US

IV. Provider business mailing address

95 MADISON AVE SUITE 400
MORRISTOWN NJ
07960-6092
US

V. Phone/Fax

Practice location:
  • Phone: 973-625-3363
  • Fax: 973-586-6824
Mailing address:
  • Phone: 973-984-5005
  • Fax: 973-984-5554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number25MA04685200
License Number StateNJ

VIII. Authorized Official

Name: NANCY MEDFORD
Title or Position: ADMINISTRATOR
Credential:
Phone: 973-984-5005