Provider Demographics
NPI:1215978408
Name:SOUTH JERSEY EYE PHYSICIANS PA
Entity type:Organization
Organization Name:SOUTH JERSEY EYE PHYSICIANS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:G
Authorized Official - Last Name:NACHBAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-234-0258
Mailing Address - Street 1:509 S LENOLA RD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-1561
Mailing Address - Country:US
Mailing Address - Phone:856-234-0258
Mailing Address - Fax:856-727-9518
Practice Address - Street 1:509 S LENOLA RD
Practice Address - Street 2:SUITE 11
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-1561
Practice Address - Country:US
Practice Address - Phone:856-234-0258
Practice Address - Fax:856-727-9518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJCA0186OtherRAILROAD MEDICARE
NJ5598206Medicaid
NJ2827301Medicaid
NJCA0186OtherRAILROAD MEDICARE
NJ669058Medicare PIN