NPIMap

Organization Active NPI

Pediatric Ophthalmology of NJ, P.C.

  • Ophthalmology Physician
  • Wayne, NJ
National Provider Identifier
1164460218
Registry record updated Apr 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
PEDIATRIC OPHTHALMOLOGY OF NJ, P.C.
Practice address
57 Willowbrook Blvd
Suite 411
Wayne, NJ 07470-7047
Phone
(973) 256-4111
Fax
(973) 256-3719
NPI assigned
Jun 2, 2006
Last updated
Apr 20, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kevin J. Mickey, M.D.NPI 1538101662
Title
President
Phone
(973) 256-4111

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X Primary
Pediatric Ophthalmology and Strabismus Specialist PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207WX0110X

Addresses

Primary practice location

57 Willowbrook Blvd
Suite 411
Wayne, NJ 07470-7047

Mailing address

57 Willowbrook Blvd
Suite 411
Wayne, NJ 07470-7047
Phone (973) 256-4111

Other identifiers 1

IdentifierTypeStateIssuer
8550204MedicaidNJ

National Provider Directory

National Provider Directory

Locations

57 Willowbrook Blvd
Ste 411
Wayne, NJ 07470
Phone (973) 256-4111

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587340800000",
    "number": "1164460218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "57 WILLOWBROOK BLVD",
            "address_2": "SUITE 411",
            "city": "WAYNE",
            "state": "NJ",
            "postal_code": "074707047",
            "telephone_number": "973-256-4111",
            "fax_number": "973-256-3719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "57 WILLOWBROOK BLVD",
            "address_2": "SUITE 411",
            "city": "WAYNE",
            "state": "NJ",
            "postal_code": "074707047",
            "telephone_number": "973-256-4111",
            "fax_number": "973-256-3719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC OPHTHALMOLOGY OF NJ, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-02",
        "last_updated": "2020-04-20",
        "certification_date": "2020-04-20",
        "status": "A",
        "authorized_official_last_name": "MICKEY",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "973-256-4111",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207WX0110X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology, Pediatric Ophthalmology and Strabismus Specialist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8550204",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wayne, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.