Provider Demographics
NPI:1902138936
Name:NJ EYE PROFESSIONALS, LLC
Entity Type:Organization
Organization Name:NJ EYE PROFESSIONALS, LLC
Other - Org Name:EYE PROFESSIONALS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ZENITH
Authorized Official - Middle Name:Y
Authorized Official - Last Name:YLANAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:908-222-8773
Mailing Address - Street 1:1308 CENTENNIAL AVE
Mailing Address - Street 2:SUITE 345
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-4324
Mailing Address - Country:US
Mailing Address - Phone:908-222-8773
Mailing Address - Fax:908-222-8771
Practice Address - Street 1:906 OAK TREE AVE
Practice Address - Street 2:SUITE I
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-5127
Practice Address - Country:US
Practice Address - Phone:908-222-8773
Practice Address - Fax:908-222-8771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06158600207W00000X
NJ25MA06628500207W00000X
NJ25MA02048600207W00000X
NJ25MA08315500207W00000X
NJ25MA08442900207W00000X
NJ25MA03966500207W00000X
NJ27OA0343600207W00000X
NY103383-2207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA03966500OtherNJ LICENSE
NJ25MA08315500OtherNJ LICENCE
NJ25MA08442900OtherNJ LICENSE
NJT91758Medicare UPIN
NJG56027Medicare UPIN
NJA68168Medicare UPIN
NJ25MA03966500OtherNJ LICENSE