Provider Demographics
NPI:1144475005
Name:MORILLO EYE ASSOCIATES
Entity type:Organization
Organization Name:MORILLO EYE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIEGO
Authorized Official - Middle Name:
Authorized Official - Last Name:MORILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-206-3409
Mailing Address - Street 1:875 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-2622
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:875 BROAD ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-2622
Practice Address - Country:US
Practice Address - Phone:973-622-4492
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00566200152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4492662OtherVISION SERVICE PLAN
NJ8277508Medicaid
29726OtherSPECTERA
52588OtherDAVIS VISION
NJ8277508Medicaid
29726OtherSPECTERA