Healthcare Provider Details

I. General information

NPI: 1427078930
Provider Name (Legal Business Name): RETINA CONSULTANTS SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 06/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 SYCAMORE AVE
LITTLE SILVER NJ
07739-1208
US

IV. Provider business mailing address

39 SYCAMORE AVE
LITTLE SILVER NJ
07739-1208
US

V. Phone/Fax

Practice location:
  • Phone: 732-530-7730
  • Fax: 732-530-3837
Mailing address:
  • Phone: 732-530-7730
  • Fax: 732-530-3837

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: MARTIN URAM
Title or Position: OWNER
Credential: M.D.
Phone: 732-530-7730