Basic Information
| Provider Information | |||||||||
| NPI: | 1164578894 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASSOCIATED RETINAL CONSULTANTS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 420 MOUNTAIN AVE FL 4 | ||||||||
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| City: | NEW PROVIDENCE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079742736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9084588333 | ||||||||
| FaxNumber: | 9089675488 | ||||||||
| Practice Location | |||||||||
| Address1: | 2952 VAUXHALL RD | ||||||||
| Address2: | |||||||||
| City: | VAUXHALL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070881246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9084588333 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2007 | ||||||||
| LastUpdateDate: | 06/28/2021 | ||||||||
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| AuthorizedOfficialLastName: | MADREPERLA | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9084588313 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 06/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | N | 193200000X MULTI-SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist | 207WX0107X | N | 193200000X MULTI-SPECIALTY GROUP | 207W00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.