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General NPI Number Information
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NPI Number | 1114972148
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Entity Type | Organization
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Legal Business Name | PEDIATRIC OPHTHALMOLOGY ASSOCIATES, PA
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Dates
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Enumeration Date | 05/25/2006
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Last Update Date | 08/11/2010
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Provider Practice Location Address
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Address Line | 218 RIDGEDALE AVE SUITE 100
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City | CEDAR KNOLLS
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State | NJ
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Zip | 07927-2109
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Country | US
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Telephone | 973-326-8895
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Fax | 973-326-6805
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Provider Business Mailing Address
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Address Line | 218 RIDGEDALE AVE SUITE 100
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City | CEDAR KNOLLS
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State | NJ
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Zip | 07927-2109
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Country | US
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Telephone | 973-326-8895
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Fax | 973-326-6805
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAY M. BERNSTEIN
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Credential | M.D.
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Telephone | 973-326-8895
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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