Provider Demographics
NPI:1053762724
Name:JERSEY SHORE OPHTHALMOLOGY RETINA CONSULTANTS, LLC
Entity type:Organization
Organization Name:JERSEY SHORE OPHTHALMOLOGY RETINA CONSULTANTS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:
Authorized Official - Last Name:EZON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-241-6666
Mailing Address - Street 1:133 VAN NOSTRAND AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4306
Mailing Address - Country:US
Mailing Address - Phone:732-241-6666
Mailing Address - Fax:888-604-9076
Practice Address - Street 1:241 MONMOUTH RD
Practice Address - Street 2:SUITE 102
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764-1177
Practice Address - Country:US
Practice Address - Phone:732-738-4627
Practice Address - Fax:888-604-9076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09591700207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty