Basic Information
| Provider Information | |||||||||
| NPI: | 1265057293 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASSOCIATED RETINAL CONSULTANTS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 GALLOPING HILL RD STE 304 | ||||||||
| Address2: | |||||||||
| City: | UNION | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070837991 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9084588333 | ||||||||
| FaxNumber: | 9088454010 | ||||||||
| Practice Location | |||||||||
| Address1: | 517 ROUTE 1 STE 1100 | ||||||||
| Address2: | |||||||||
| City: | ISELIN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088303011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7326367497 | ||||||||
| FaxNumber: | 7326367497 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2020 | ||||||||
| LastUpdateDate: | 06/16/2020 | ||||||||
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| AuthorizedOfficialLastName: | RODRIGUEZ | ||||||||
| AuthorizedOfficialFirstName: | FRANK | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9084588333 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 0150274 | 05 | NJ | MEDICAID |