Provider Demographics
NPI:1619936648
Name:HADLEY, PAUL MANSFIELD (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:MANSFIELD
Last Name:HADLEY
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 1:10 SHAWNEE DR
Mailing Address - Street 2:
Mailing Address - City:WATCHUNG
Mailing Address - State:NJ
Mailing Address - Zip Code:07069-5803
Mailing Address - Country:US
Mailing Address - Phone:908-754-4333
Mailing Address - Fax:908-743-4334
Practice Address - Street 1:10 SHAWNEE DR
Practice Address - Street 2:
Practice Address - City:WATCHUNG
Practice Address - State:NJ
Practice Address - Zip Code:07069-5803
Practice Address - Country:US
Practice Address - Phone:908-754-4333
Practice Address - Fax:908-743-4334
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ02987152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ540252OtherAETNA
NJ1607308Medicaid
NJ521366Medicare PIN
NJ1607308Medicaid
NJ0140350001Medicare NSC