Healthcare Provider Details

I. General information

NPI: 1447319579
Provider Name (Legal Business Name): PHILLIPS EYE CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 HOW LN SUITE 2B
NORTH BRUNSWICK NJ
08902-4600
US

IV. Provider business mailing address

PO BOX 7184
NORTH BRUNSWICK NJ
08902-7184
US

V. Phone/Fax

Practice location:
  • Phone: 732-249-6164
  • Fax: 732-418-1976
Mailing address:
  • Phone: 732-249-6164
  • Fax: 732-418-1976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1100X
TaxonomyOphthalmic Technician/Technologist
License Number
License Number State

VIII. Authorized Official

Name: DR. FAY LOLITA BENNETT
Title or Position: PRESIDENT
Credential: MD
Phone: 732-249-6164