Basic Information
| Provider Information | |||||||||
| NPI: | 1457369738 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RETINA ASSOCIATES OF NEW JERSEY PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1700 GALLOPING HILL RD | ||||||||
| Address2: | |||||||||
| City: | KENILWORTH | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070331303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9084588333 | ||||||||
| FaxNumber: | 9084588339 | ||||||||
| Practice Location | |||||||||
| Address1: | 1700 GALLOPING HILL RD | ||||||||
| Address2: | |||||||||
| City: | KENILWORTH | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9084588333 | ||||||||
| FaxNumber: | 9084588339 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2006 | ||||||||
| LastUpdateDate: | 06/05/2018 | ||||||||
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| AuthorizedOfficialLastName: | HARRIS | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | M.D. | ||||||||
| AuthorizedOfficialTelephone: | 9084588333 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology | 207WX0107X | Y | 193200000X MULTI-SPECIALTY GROUP |
No ID Information.