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General NPI Number Information
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NPI Number | 1992740203
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Entity Type | Organization
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Legal Business Name | RETINA SPECIALISTS OF NEW JERSEY LLC
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 01/22/2015
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Provider Practice Location Address
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Address Line | 422 COVENTRY DR FL 2
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City | PHILLIPSBURG
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State | NJ
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Zip | 08865-1969
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Country | US
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Telephone | 973-871-2020
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Fax | 973-871-2000
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Provider Business Mailing Address
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Address Line | 422 COVENTRY DR FL 2
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City | PHILLIPSBURG
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State | NJ
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Zip | 08865-1969
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Country | US
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Telephone | 973-871-2020
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Fax | 973-871-2000
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | SEAN C LALIN
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Credential | MD
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Telephone | 973-871-2020
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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 | 25MA08077000
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License Number State | NJ
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