Healthcare Provider Details

I. General information

NPI: 1033294640
Provider Name (Legal Business Name): NORTHERN NEW JERSEY EYE INSTITUTE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 2ND ST
SOUTH ORANGE NJ
07079-1855
US

IV. Provider business mailing address

71 2ND ST
SOUTH ORANGE NJ
07079-1855
US

V. Phone/Fax

Practice location:
  • Phone: 973-763-2203
  • Fax: 973-762-9449
Mailing address:
  • Phone: 973-763-2203
  • Fax: 973-762-9449

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: BERNARD C SPIER
Title or Position: OWNER
Credential: MD
Phone: 973-763-2203