Provider Demographics
NPI:1477532661
Name:SONENBLUM, PAUL L (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:L
Last Name:SONENBLUM
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 1:500 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2500
Mailing Address - Country:US
Mailing Address - Phone:732-462-8707
Mailing Address - Fax:732-780-3699
Practice Address - Street 1:500 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2500
Practice Address - Country:US
Practice Address - Phone:732-462-8707
Practice Address - Fax:732-780-3699
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2014-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOA587100152W00000X
NJTO126400152W00000X
NJOM0012300152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU98161Medicare UPIN
NJ075681V3XMedicare PIN
NJ075681V3VMedicare PIN