Advanced Family Eyecare

Primary specialty

Corneal and Contact Management OptometristTaxonomy code 152WC0802X

License

27OA00592000 Issued in NJ

Legal business name

ADVANCED FAMILY EYECARE

Practice address

1005 S Maple Ave
Glen Rock, NJ 07452-2820

Phone

(201) 444-8277

NPI assigned

Aug 18, 2017

Organization subpart

No

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

Authorized official

Name

Simki Shah, OD

Title

Sole Owner

Phone

(201) 444-8277

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1503014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1512086400000",
    "number": "1477079697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3070 BRISTOL PIKE STE 2-220",
            "city": "BENSALEM",
            "state": "PA",
            "postal_code": "190205361",
            "telephone_number": "215-497-1001",
            "fax_number": "215-639-2486"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 S MAPLE AVE",
            "city": "GLEN ROCK",
            "state": "NJ",
            "postal_code": "074522820",
            "telephone_number": "201-444-8277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED FAMILY EYECARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-18",
        "last_updated": "2017-12-01",
        "status": "A",
        "authorized_official_last_name": "SHAH",
        "authorized_official_first_name": "SIMKI",
        "authorized_official_title_or_position": "SOLE OWNER",
        "authorized_official_telephone_number": "201-444-8277",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152WC0802X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "NJ",
            "license": "27OA00592000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "1037105",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kendall Rae Ackerman, OTD, OTR/L
• Connie Putrino Adamek, NP
• Advanced Medical & Cosmetic Center LLC
• Advanced Medical and Skin Care LLC
• Thomas Nesbitt Ahlborn, M.D.
• Leah Alcid, ANP
• Luisa Antoine, LCSW

• All providers in Glen Rock, NJ
• Corneal and Contact Management Optometrist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2017; 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.