Basic Information
| Provider Information | |||||||||
| NPI: | 1306414065 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASSOCIATED RETINAL CONSULTANTS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 420 MOUNTAIN AVE FL 4 | ||||||||
| Address2: | |||||||||
| City: | NEW PROVIDENCE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079742736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9082587555 | ||||||||
| FaxNumber: | 9089675488 | ||||||||
| Practice Location | |||||||||
| Address1: | 2021 NEW RD | ||||||||
| Address2: | |||||||||
| City: | LINWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082211045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6099273373 | ||||||||
| FaxNumber: | 6099274041 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2021 | ||||||||
| LastUpdateDate: | 06/17/2021 | ||||||||
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| AuthorizedOfficialLastName: | ABREU | ||||||||
| AuthorizedOfficialFirstName: | JOSAFA | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP REVENUE CYCLE | ||||||||
| AuthorizedOfficialTelephone: | 9082587555 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ASSOCIATED RETINAL CONSULTANTS, LLC | ||||||||
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| NPICertificationDate: | 06/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.