Provider Demographics
NPI:1134143183
Name:NEVELOFF, ROBERT ALEXANDER (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALEXANDER
Last Name:NEVELOFF
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 1:86 WESTFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-2427
Mailing Address - Country:US
Mailing Address - Phone:732-381-3113
Mailing Address - Fax:732-381-3114
Practice Address - Street 1:86 WESTFIELD AVE
Practice Address - Street 2:
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-2427
Practice Address - Country:US
Practice Address - Phone:732-381-3113
Practice Address - Fax:732-381-3114
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4648152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0211401Medicaid
NJ0211401Medicaid
653962Medicare PIN