Organization
PEDIATRIC OPHTHALMOLOGY OF NJ, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN J. MICKEY M.D. (PRESIDENT)
(973) 256-4111
Entity
Organization
Contact information
Practice address
57 WILLOWBROOK BLVD, SUITE 411, WAYNE, NJ 07470-7047
(973) 256-4111
(973) 256-3719
Mailing address
57 WILLOWBROOK BLVD, SUITE 411, WAYNE, NJ 07470-7047
(973) 256-4111
(973) 256-3719
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
207WX0110X
Pediatric Ophthalmology and Strabismus Specialist Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8550204
—
NJ
Enumeration date
06/02/2006
Last updated
04/20/2020
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