Provider Demographics
NPI:1013914175
Name:SIWOFF, RONALD (OD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:SIWOFF
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 1:75 BLOOMFIELD AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-2734
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:07834-2734
Practice Address - Country:US
Practice Address - Phone:973-627-7787
Practice Address - Fax:973-627-7701
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2010-05-28
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
NJ27OA003818152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ410047651OtherRAILROAD MEDICARE
NJ2795942OtherAETNA
NJ78022238353240OtherHORIZON BC/BS
NJU26862Medicare UPIN
NJ78022238353240OtherHORIZON BC/BS