Healthcare Provider Details

I. General information

NPI: 1285222877
Provider Name (Legal Business Name): EHG NJ SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2021
Last Update Date: 11/13/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 ROUTE 22 EAST
SPRINGFIELD NJ
07081-3554
US

IV. Provider business mailing address

275 ROUTE 22 EAST
SPRINGFIELD NJ
07081-3554
US

V. Phone/Fax

Practice location:
  • Phone: 321-537-9979
  • Fax:
Mailing address:
  • Phone: 973-376-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: EDWARD SANTOS
Title or Position: COO
Credential:
Phone: 973-376-7900