Healthcare Provider Details

I. General information

NPI: 1730361981
Provider Name (Legal Business Name): NEW VISION LASER CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2007
Last Update Date: 02/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 WILLIAMSON ST SUITE 504
ELIZABETH NJ
07202-3674
US

IV. Provider business mailing address

240 WILLIAMSON ST SUITE 504
ELIZABETH NJ
07202-3674
US

V. Phone/Fax

Practice location:
  • Phone: 908-994-5618
  • Fax: 908-994-5621
Mailing address:
  • Phone: 908-994-5618
  • Fax: 908-994-5621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JUSTIN MANG
Title or Position: OWNER
Credential: M.D.
Phone: 908-289-0250