Provider Demographics
NPI:1447462312
Name:YASGUR EYE ASSOCIATES P.C.
Entity type:Organization
Organization Name:YASGUR EYE ASSOCIATES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:H
Authorized Official - Last Name:YASGUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-429-0997
Mailing Address - Street 1:1415 MARLTON PIKE E
Mailing Address - Street 2:SUITE 404
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-2210
Mailing Address - Country:US
Mailing Address - Phone:856-429-0997
Mailing Address - Fax:856-429-4799
Practice Address - Street 1:1415 MARLTON PIKE E
Practice Address - Street 2:SUITE 404
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-2210
Practice Address - Country:US
Practice Address - Phone:856-429-0997
Practice Address - Fax:856-429-4799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25 MA039265207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2401002Medicaid
NJ093558Medicare ID - Type UnspecifiedMEDICARE
NJ2401002Medicaid
NJ4688330001Medicare NSC