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General NPI Number Information
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NPI Number | 1336193994
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Entity Type | Organization
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Legal Business Name | DELAWARE VALLEY RETINA ASSOCIATES PC
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 04/23/2014
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Provider Practice Location Address
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Address Line | 4 PRINCESS RD BUILDING 100, SUITE 101
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City | LAWRENCEVILLE
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State | NJ
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Zip | 08648-2322
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Country | US
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Telephone | 609-896-1414
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Fax | 609-896-2982
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Provider Business Mailing Address
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Address Line | 4 PRINCESS RD BUILDING 100, SUITE 101
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City | LAWRENCEVILLE
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State | NJ
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Zip | 08648-2322
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Country | US
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Telephone | 609-896-1414
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Fax | 609-896-2982
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DARMAKUSUMA IE
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Credential | M.D.
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Telephone | 609-896-1414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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