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General NPI Number Information
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NPI Number | 1760788996
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Entity Type | Organization
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Legal Business Name | VITREOUS RETINA MACULA SPECIALISTS OF NJ
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Dates
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Enumeration Date | 02/05/2011
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Last Update Date | 09/20/2018
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Provider Practice Location Address
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Address Line | 306 MAIN STREET 2ND FLOOR
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City | MILLBURN
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State | NJ
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Zip | 07041-1737
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Country | US
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Telephone | 973-467-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 306 MAIN STREET 2ND FLOOR
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City | MILLBURN
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State | NJ
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Zip | 07041-1178
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Country | US
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Telephone | 917-573-0084
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. VATSAL DOSHI
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Credential | MD
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Telephone | 917-573-0084
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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 | 25MA08558900
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License Number State | NJ
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