Healthcare Provider Details

I. General information

NPI: 1366414633
Provider Name (Legal Business Name): MIDATLANTIC EYE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 02/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 E FRONT ST
RED BANK NJ
07701-1851
US

IV. Provider business mailing address

70 E FRONT ST
RED BANK NJ
07701-1851
US

V. Phone/Fax

Practice location:
  • Phone: 732-741-0858
  • Fax: 732-219-0180
Mailing address:
  • Phone: 732-741-0858
  • Fax: 732-219-0180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. WALTER J KAHN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 732-741-0858