Provider Demographics
NPI:1215985544
Name:COASTAL JERSEY EYE CENTER LLC
Entity type:Organization
Organization Name:COASTAL JERSEY EYE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:H
Authorized Official - Last Name:URETSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-927-3373
Mailing Address - Street 1:2021 NEW ROAD
Mailing Address - Street 2:STE 6
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221
Mailing Address - Country:US
Mailing Address - Phone:609-927-3373
Mailing Address - Fax:609-927-4041
Practice Address - Street 1:2021 NEW ROAD
Practice Address - Street 2:STE 6
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221
Practice Address - Country:US
Practice Address - Phone:609-927-3373
Practice Address - Fax:609-927-4041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1669921OtherPPO AMERIHEALTH
3724882OtherAETNA
NJ086183OtherMEDICARE
GADC5481OtherRAILROAD MEDICARE
2345288000OtherHMO AMERIHEALTH
3724882OtherAETNA
NJ086183Medicare PIN