Healthcare Provider Details

I. General information

NPI: 1619940343
Provider Name (Legal Business Name): OPHTHALMIC PARTNERS OF NEW JERSEY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 07/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 ROUTE 70 EAST, SUITE F-180 ELMWOOD BUSINESS PARK
MARLTON NJ
08053
US

IV. Provider business mailing address

100 PRESIDENTIAL BLVD SUITE 200
BALA CYNWYD PA
19004-1108
US

V. Phone/Fax

Practice location:
  • Phone: 856-985-7152
  • Fax: 856-983-0396
Mailing address:
  • Phone: 484-434-2700
  • Fax: 610-660-0419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG002793
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number25MA06655300
License Number StateNJ

VIII. Authorized Official

Name: JULIA LEE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 610-660-0446