Provider Demographics
NPI:1366494486
Name:SCHKOLNICK, JOSEPH ANDREW (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ANDREW
Last Name:SCHKOLNICK
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 1:616 BLOOMFIELD AVE STE 3B
Mailing Address - Street 2:
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-7585
Mailing Address - Country:US
Mailing Address - Phone:973-228-9786
Mailing Address - Fax:973-228-5427
Practice Address - Street 1:616 BLOOMFIELD AVE STE 3B
Practice Address - Street 2:
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-7585
Practice Address - Country:US
Practice Address - Phone:973-228-9786
Practice Address - Fax:973-228-5427
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00478800152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1344501Medicaid
SC521703Medicare ID - Type Unspecified
T82492Medicare UPIN