Provider Demographics
NPI:1447319579
Name:PHILLIPS EYE CONSULTANTS
Entity type:Organization
Organization Name:PHILLIPS EYE CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FAY
Authorized Official - Middle Name:LOLITA
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-249-6164
Mailing Address - Street 1:PO BOX 7184
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-7184
Mailing Address - Country:US
Mailing Address - Phone:732-249-6164
Mailing Address - Fax:732-418-1976
Practice Address - Street 1:1440 HOW LN
Practice Address - Street 2:SUITE 2B
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-4600
Practice Address - Country:US
Practice Address - Phone:732-249-6164
Practice Address - Fax:732-418-1976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ017263Medicare ID - Type Unspecified