Provider Demographics
NPI:1972756757
Name:DR. ROBERT SCHORN PURNELL LLC
Entity Type:Organization
Organization Name:DR. ROBERT SCHORN PURNELL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:SCHORN
Authorized Official - Last Name:PURNELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:201-939-2463
Mailing Address - Street 1:31 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-1711
Mailing Address - Country:US
Mailing Address - Phone:201-939-2463
Mailing Address - Fax:201-939-1454
Practice Address - Street 1:31 PARK AVE
Practice Address - Street 2:
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-1711
Practice Address - Country:US
Practice Address - Phone:201-939-2463
Practice Address - Fax:201-939-1454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-24
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OM00041400152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1815202Medicaid
NJ7714106Medicaid
NJ1815202Medicaid
NJU11812Medicare UPIN