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General NPI Number Information
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NPI Number | 1518377688
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Entity Type | Organization
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Legal Business Name | HATHAWAY EYECARE, LLC
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Dates
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Enumeration Date | 04/29/2014
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Last Update Date | 04/29/2014
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Provider Practice Location Address
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Address Line | 49 VERONICA AVE SUITE 204
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City | SOMERSET
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State | NJ
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Zip | 08873-6802
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Country | US
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Telephone | 732-565-1500
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Fax | 732-565-1501
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Provider Business Mailing Address
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Address Line | PO BOX 7074
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City | MONROE TOWNSHIP
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State | NJ
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Zip | 08831-9998
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Country | US
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Telephone | 732-565-1500
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ELAINE G HATHAWAY
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Credential | M.D.
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Telephone | 732-565-1500
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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 | MA06237200
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License Number State | NJ
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