Provider Demographics
NPI:1508089657
Name:WITBECK, CINDY L (TD)
Entity Type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:L
Last Name:WITBECK
Suffix:
Gender:F
Credentials:TD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 ROUTE 72 W
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-2414
Mailing Address - Country:US
Mailing Address - Phone:609-597-9494
Mailing Address - Fax:609-597-7192
Practice Address - Street 1:1206 ROUTE 72 W
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2414
Practice Address - Country:US
Practice Address - Phone:609-597-9494
Practice Address - Fax:609-597-7192
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31TD00186900156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician