Healthcare Provider Details

I. General information

NPI: 1821372467
Provider Name (Legal Business Name): THE EYE SURGICENTER OF NEW JERSEY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2011
Last Update Date: 09/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 N HIGH ST
MILLVILLE NJ
08332-2530
US

IV. Provider business mailing address

225 SUNSET RD
WILLINGBORO NJ
08046-1109
US

V. Phone/Fax

Practice location:
  • Phone: 856-825-3937
  • Fax:
Mailing address:
  • Phone: 609-877-2800
  • Fax:

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: DR. GREGORY H SCIMECA
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 609-877-2800