Provider Demographics
NPI:1669507729
Name:KIRCZOW, ROBERT GENE (OD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:GENE
Last Name:KIRCZOW
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 1:35 PHOENIX DR
Mailing Address - Street 2:
Mailing Address - City:MENDHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07945-1714
Mailing Address - Country:US
Mailing Address - Phone:973-543-9789
Mailing Address - Fax:
Practice Address - Street 1:35 PHOENIX DR
Practice Address - Street 2:
Practice Address - City:MENDHAM
Practice Address - State:NJ
Practice Address - Zip Code:07945-1714
Practice Address - Country:US
Practice Address - Phone:973-543-9789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ03765152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ030999ZFAMedicare PIN