MEDICARE: PHILADELPHIA EYE ASSOCIATES OF SOUTH JERSEY

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	207W00000X	Ophthalmology Physician

General Provider Information

NPI Number	:	1982690020
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHILADELPHIA EYE ASSOCIATES OF SOUTH JERSEY

Provider Business Mailing Address
First Line	:	1703 S BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19148-1536
Country	:	US
Telephone Number	:	609-871-1112
Fax Number	:	609-871-0002

Provider Business Practice Location Address
First Line	:	1113 HOSPITAL DR
Second Line	:	SUITE 302
City	:	WILLINGBORO
State	:	NJ
Zip	:	08046-1103
Country	:	US
Telephone Number	:	609-871-1112
Fax Number	:	609-871-0002

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	COLEEN AKKARI
Credential	:
Telephone Number	:	215-423-5154

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	12/11/2007

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