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General NPI Number Information
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NPI Number | 1538433123
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Entity Type | Organization
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Legal Business Name | EYE CARE OF RIVER EDGE LLC
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Dates
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Enumeration Date | 02/29/2012
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Last Update Date | 05/23/2012
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Provider Practice Location Address
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Address Line | 1060 MAIN ST SUITE 301
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City | RIVER EDGE
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State | NJ
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Zip | 07661-2591
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Country | US
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Telephone | 201-489-0096
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Fax | 201-489-2930
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Provider Business Mailing Address
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Address Line | 1060 MAIN ST SUITE 301
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City | RIVER EDGE
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State | NJ
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Zip | 07661-2591
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Country | US
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Telephone | 201-489-0096
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Fax | 201-489-2930
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Authorized Official
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Title or Position | OPHTHALMOLOGY
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Name | DR. MARTA R PONCE-CONTRERAS
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Credential | M.D.
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Telephone | 201-489-0096
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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 | 25MA08184500
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License Number State | NJ
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