Provider Demographics
NPI:1760605075
Name:WERTHEIM, ALINA D (OD)
Entity Type:Individual
Prefix:DR
First Name:ALINA
Middle Name:D
Last Name:WERTHEIM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 WINDSOR RD
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-2642
Mailing Address - Country:US
Mailing Address - Phone:917-226-1086
Mailing Address - Fax:
Practice Address - Street 1:789 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-8163
Practice Address - Country:US
Practice Address - Phone:212-792-8123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006088-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist