Provider Demographics
NPI:1962745380
Name:JERSEY VISION CONSULTANTS INC
Entity type:Organization
Organization Name:JERSEY VISION CONSULTANTS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:CONFORTI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:732-536-0664
Mailing Address - Street 1:700 TENNENT RD
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-3162
Mailing Address - Country:US
Mailing Address - Phone:732-536-0664
Mailing Address - Fax:732-536-2314
Practice Address - Street 1:700 TENNENT RD
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-3162
Practice Address - Country:US
Practice Address - Phone:732-536-0664
Practice Address - Fax:732-536-2314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00462100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6097901Medicaid
1619014297OtherNPI # DR WILLIAM CONFORTI
NJ447256Medicare UPIN