Provider Demographics
NPI:1548234941
Name:WERTHAIM, OFER AVI (MD)
Entity Type:Individual
Prefix:DR
First Name:OFER
Middle Name:AVI
Last Name:WERTHAIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:OFER
Other - Middle Name:AVI
Other - Last Name:WERTHAIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:579 CRANBURY RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5405
Mailing Address - Country:US
Mailing Address - Phone:732-238-6800
Mailing Address - Fax:732-238-9696
Practice Address - Street 1:579 CRANBURY RD
Practice Address - Street 2:SUITE A
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5405
Practice Address - Country:US
Practice Address - Phone:732-238-6800
Practice Address - Fax:732-238-9696
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA54702207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE69478Medicare UPIN
NJ647045X2LMedicare PIN