Healthcare Provider Details

I. General information

NPI: 1356860811
Provider Name (Legal Business Name): NJ EYE AND EAR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 W PALISADE AVE
ENGLEWOOD NJ
07631-2705
US

IV. Provider business mailing address

17 W PALISADE AVE
ENGLEWOOD NJ
07631-2705
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 Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL STEGMAN
Title or Position: OWNER
Credential: MD
Phone: 973-546-5700