Provider Demographics
NPI:1558328245
Name:PENEIRAS, SERGIO (OD)
Entity Type:Individual
Prefix:
First Name:SERGIO
Middle Name:
Last Name:PENEIRAS
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 1:22 BUNKER HILL RD
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-1381
Mailing Address - Country:US
Mailing Address - Phone:732-410-4640
Mailing Address - Fax:
Practice Address - Street 1:225 GORDONS CORNER RD
Practice Address - Street 2:SUITE 1C
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-3356
Practice Address - Country:US
Practice Address - Phone:732-792-9800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ270A0056760152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8358401Medicaid
NJ039686BCRMedicare ID - Type Unspecified
NJU81056Medicare UPIN