Healthcare Provider Details

I. General information

NPI: 1174083729
Provider Name (Legal Business Name): ANDREW JOSEPH INES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 S LINCOLN AVE
VINELAND NJ
08361-7802
US

IV. Provider business mailing address

420 MOUNTAIN AVE FL 4
NEW PROVIDENCE NJ
07974-2736
US

V. Phone/Fax

Practice location:
  • Phone: 856-691-8188
  • Fax: 856-691-0421
Mailing address:
  • Phone: 908-458-8333
  • Fax: 908-967-5488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number25MA12253400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD481216
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: