Provider Demographics
NPI:1386048510
Name:OPHTHALMIC CONSULTANTS OF NEW JERSEY, P.C.
Entity type:Organization
Organization Name:OPHTHALMIC CONSULTANTS OF NEW JERSEY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-708-3937
Mailing Address - Street 1:620 CRANBURY RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-4098
Mailing Address - Country:US
Mailing Address - Phone:732-708-3937
Mailing Address - Fax:609-228-5120
Practice Address - Street 1:620 CRANBURY RD
Practice Address - Street 2:SUITE 205
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-4098
Practice Address - Country:US
Practice Address - Phone:732-708-3937
Practice Address - Fax:609-228-5120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-17
Last Update Date:2015-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08228100207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
381652Medicare PIN