Provider Demographics
NPI:1760797039
Name:SPIEWAK, MAGDALENA (OD)
Entity Type:Individual
Prefix:
First Name:MAGDALENA
Middle Name:
Last Name:SPIEWAK
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 1:333 FORSGATE DR
Mailing Address - Street 2:UNIT 6
Mailing Address - City:JAMESBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-1567
Mailing Address - Country:US
Mailing Address - Phone:732-656-1515
Mailing Address - Fax:
Practice Address - Street 1:333 FORSGATE DR
Practice Address - Street 2:UNIT 6
Practice Address - City:JAMESBURG
Practice Address - State:NJ
Practice Address - Zip Code:08831-1567
Practice Address - Country:US
Practice Address - Phone:732-656-1515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-11
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007480-1152W00000X
NJ27OA00638001152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ243866Medicare PIN