Provider Demographics
NPI:1851300669
Name:SHTEIR, MARK (OD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:SHTEIR
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 1:3013 STATE ROUTE 35
Mailing Address - Street 2:HAZLET PLAZA
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730-1526
Mailing Address - Country:US
Mailing Address - Phone:732-739-4000
Mailing Address - Fax:732-739-4002
Practice Address - Street 1:3013 STATE ROUTE 35
Practice Address - Street 2:HAZLET PLAZA
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1526
Practice Address - Country:US
Practice Address - Phone:732-739-4000
Practice Address - Fax:732-739-4002
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00300100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4786904Medicaid
NJ152173VBNMedicare PIN
NJ4786904Medicaid
NJU26524Medicare UPIN