Provider Demographics
NPI:1871779678
Name:ATLANTIC OPHTHALMOLOGY & COSMETIC EYELID SURGERY
Entity type:Organization
Organization Name:ATLANTIC OPHTHALMOLOGY & COSMETIC EYELID SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-227-0062
Mailing Address - Street 1:1129 BLOOMFIELD AVE
Mailing Address - Street 2:SUITE 218
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-7127
Mailing Address - Country:US
Mailing Address - Phone:973-227-0062
Mailing Address - Fax:973-287-6921
Practice Address - Street 1:1129 BLOOMFIELD AVE
Practice Address - Street 2:SUITE 218
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-7127
Practice Address - Country:US
Practice Address - Phone:973-227-0062
Practice Address - Fax:973-287-6921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07829700207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0084212Medicaid
NJH79507Medicare UPIN
NJ0084212Medicaid