Healthcare Provider Details

I. General information

NPI: 1689865321
Provider Name (Legal Business Name): MILLENNIUM EYE CARE,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 11/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 W COUNTY LINE RD
JACKSON NJ
08527-2009
US

IV. Provider business mailing address

500 W MAIN ST
FREEHOLD NJ
07728-2500
US

V. Phone/Fax

Practice location:
  • Phone: 732-364-5123
  • Fax: 732-364-3865
Mailing address:
  • Phone: 732-462-8707
  • Fax: 732-780-3699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number25MA05082500
License Number StateNJ

VIII. Authorized Official

Name: DR. STEVEN MISHKIN
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 732-462-8707