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General NPI Number Information
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NPI Number | 1104097880
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Entity Type | Organization
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Legal Business Name | MT HOLLY EYE PHYSICIANS AND SURGEONS
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Dates
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Enumeration Date | 03/20/2008
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Last Update Date | 03/20/2008
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Provider Practice Location Address
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Address Line | 1613 ROUTE 38
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City | LUMBERTON
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State | NJ
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Zip | 08048-2921
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Country | US
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Telephone | 609-267-5577
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Fax | 609-267-5570
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Provider Business Mailing Address
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Address Line | 1613 ROUTE 38
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City | LUMBERTON
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State | NJ
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Zip | 08048-2921
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Country | US
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Telephone | 609-267-5577
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Fax | 609-267-5570
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Authorized Official
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Title or Position | PRESIDENT
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Name | HARRY GROSSMAN
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Credential | MD
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Telephone | 609-267-5577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | MA65455
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License Number State | NJ
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