Provider Demographics
NPI:1063459212
Name:WITLIN, RICHARD S (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:S
Last Name:WITLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:557 CRANBURY RD
Mailing Address - Street 2:SUITE 15
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5419
Mailing Address - Country:US
Mailing Address - Phone:732-698-9300
Mailing Address - Fax:732-625-0107
Practice Address - Street 1:557 CRANBURY RD
Practice Address - Street 2:SUITE 15
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5419
Practice Address - Country:US
Practice Address - Phone:732-698-9300
Practice Address - Fax:732-625-0107
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2010-08-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJMA03593300207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ176675Medicare PIN
NJC57524Medicare UPIN