Healthcare Provider Details

I. General information

NPI: 1477288835
Provider Name (Legal Business Name): NEW JERSEY EYE CENTER, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2022
Last Update Date: 07/20/2022
Certification Date: 07/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 MAPLE AVE
GLEN ROCK NJ
07452-2820
US

IV. Provider business mailing address

1 N WASHINGTON AVE
BERGENFIELD NJ
07621-2125
US

V. Phone/Fax

Practice location:
  • Phone: 201-444-8277
  • Fax: 201-384-3231
Mailing address:
  • Phone: 201-384-7333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DANA STEVENS
Title or Position: PRACTICE MANAGER
Credential:
Phone: 201-384-7333