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General NPI Number Information
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NPI Number | 1407262595
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Entity Type | Organization
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Legal Business Name | ACADEMIC EYE CENTER, PA
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Dates
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Enumeration Date | 07/09/2014
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Last Update Date | 10/03/2014
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Provider Practice Location Address
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Address Line | 192 SUMMERHILL RD
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-4908
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Country | US
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Telephone | 732-257-4900
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Fax | 732-432-9458
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Provider Business Mailing Address
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Address Line | 192 SUMMERHILL RD
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-4908
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Country | US
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Telephone | 732-257-4900
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Fax | 732-432-9458
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN KUNG
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Credential | M.D.
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Telephone | 732-257-4900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 25MA06008800
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License Number State | NJ
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