Provider Demographics
NPI:1154417392
Name:CHOE, NANCY E (OD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:E
Last Name:CHOE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6206 CITY PL
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-3174
Mailing Address - Country:US
Mailing Address - Phone:267-974-7732
Mailing Address - Fax:
Practice Address - Street 1:30 MALL DR W
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07310-1615
Practice Address - Country:US
Practice Address - Phone:201-798-0303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00595700152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0050113Medicaid
NJ0050113Medicaid
NJ086619Medicare ID - Type Unspecified