Provider Demographics
NPI:1558504001
Name:ROBIN KAHWATY O D L L C
Entity Type:Organization
Organization Name:ROBIN KAHWATY O D L L C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAHWATY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-244-1369
Mailing Address - Street 1:102 KONNER AVE
Mailing Address - Street 2:
Mailing Address - City:PINE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07058-9524
Mailing Address - Country:US
Mailing Address - Phone:973-244-1369
Mailing Address - Fax:
Practice Address - Street 1:77 WILLOWBROOK BLVD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-7055
Practice Address - Country:US
Practice Address - Phone:973-890-2772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-14
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty