Healthcare Provider Details

I. General information

NPI: 1457369738
Provider Name (Legal Business Name): RETINA ASSOCIATES OF NEW JERSEY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 06/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 GALLOPING HILL RD
KENILWORTH NJ
07033
US

IV. Provider business mailing address

1700 GALLOPING HILL RD
KENILWORTH NJ
07033-1303
US

V. Phone/Fax

Practice location:
  • Phone: 908-458-8333
  • Fax: 908-458-8339
Mailing address:
  • Phone: 908-458-8333
  • Fax: 908-458-8339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL J HARRIS
Title or Position: M.D.
Credential: M.D.
Phone: 908-458-8333