Provider Demographics
NPI:1548509771
Name:COREY M. NOTIS, M.D., P.A.
Entity type:Organization
Organization Name:COREY M. NOTIS, M.D., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:M
Authorized Official - Last Name:NOTIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-232-6900
Mailing Address - Street 1:155 MORRIS AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-1225
Mailing Address - Country:US
Mailing Address - Phone:973-232-6900
Mailing Address - Fax:973-232-6912
Practice Address - Street 1:900 STUYVESANT AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-6936
Practice Address - Country:US
Practice Address - Phone:908-687-0330
Practice Address - Fax:908-687-0139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA053905207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7116004Medicaid
NJ073502Medicare PIN
NJ1186950001Medicare NSC
NJF54493Medicare UPIN