MEDICARE: MR. PATRICK S EYE APRN, BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	26NJ00098600	NJ

General Provider Information

NPI Number	:	1497768337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PATRICK S EYE APRN, BC

Provider Business Mailing Address
First Line	:	210 S SHORE RD
Second Line	:	SUITE 201
City	:	MARMORA
State	:	NJ
Zip	:	08223-1200
Country	:	US
Telephone Number	:	609-390-7814
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 S SHORE RD
Second Line	:	SUITE 201
City	:	MARMORA
State	:	NJ
Zip	:	08223-1200
Country	:	US
Telephone Number	:	609-390-7814
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	08/12/2009

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