Provider Demographics
NPI:1710254032
Name:SIWOFF LOW VISION CENTER, P.C.
Entity Type:Organization
Organization Name:SIWOFF LOW VISION CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:SIWOFF
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:973-627-7787
Mailing Address - Street 1:75 BLOOMFIELD AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-2736
Mailing Address - Country:US
Mailing Address - Phone:973-627-7787
Mailing Address - Fax:973-627-7701
Practice Address - Street 1:75 BLOOMFIELD AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2735
Practice Address - Country:US
Practice Address - Phone:973-627-7787
Practice Address - Fax:973-627-7701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00381800152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ521315Medicare UPIN