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Organization

DELAWARE VALLEY RETINA ASSOCIATES PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DARMAKUSUMA IE M.D. (VICE PRESIDENT)
(609) 896-1414
Entity
Organization

Contact information

Practice address
4 PRINCESS RD, BUILDING 100, SUITE 101, LAWRENCEVILLE, NJ 08648-2322
(609) 896-1414
(609) 896-2982
Mailing address
4 PRINCESS RD, BUILDING 100, SUITE 101, LAWRENCEVILLE, NJ 08648-2322
(609) 896-1414
(609) 896-2982

Taxonomy

Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1336193994
CHAMPUS/TRICARE PGBA
NJ
01
CC5703
RAILROAD MEDICARE
NJ
01
CI9130
RAILROAD MEDICARE
NJ
01
CI9131
RAILROAD MEDICARE
PA
Enumeration date
05/19/2006
Last updated
04/23/2014
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