Provider Demographics
NPI:1346243193
Name:GREENSPAN, SHELDON GERARD (OD)
Entity Type:Individual
Prefix:DR
First Name:SHELDON
Middle Name:GERARD
Last Name:GREENSPAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1259 ROUTE 46
Mailing Address - Street 2:STE 4B
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-4909
Mailing Address - Country:US
Mailing Address - Phone:973-263-9400
Mailing Address - Fax:973-263-3376
Practice Address - Street 1:1259 ROUTE 46
Practice Address - Street 2:STE 4B
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-4909
Practice Address - Country:US
Practice Address - Phone:973-263-9400
Practice Address - Fax:973-263-3376
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ270A00361700152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ011455Medicare ID - Type Unspecified
NJ521326Medicare PIN
NJ0643370001Medicare NSC
NJU23944Medicare UPIN