Provider Demographics
NPI:1538433123
Name:EYE CARE OF RIVER EDGE LLC
Entity type:Organization
Organization Name:EYE CARE OF RIVER EDGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPHTHALMOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTA
Authorized Official - Middle Name:R
Authorized Official - Last Name:PONCE-CONTRERAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-489-0096
Mailing Address - Street 1:1060 MAIN ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:RIVER EDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07661-2591
Mailing Address - Country:US
Mailing Address - Phone:201-489-0096
Mailing Address - Fax:201-489-2930
Practice Address - Street 1:1060 MAIN ST
Practice Address - Street 2:SUITE 301
Practice Address - City:RIVER EDGE
Practice Address - State:NJ
Practice Address - Zip Code:07661-2591
Practice Address - Country:US
Practice Address - Phone:201-489-0096
Practice Address - Fax:201-489-2930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-29
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08184500207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ387749500OtherAMERIHEALTH
NJ7044084OtherCIGNA
NJP4464080OtherOXFORD
NJ7223970OtherAETNA
NJP4464080OtherOXFORD