Provider Demographics
NPI:1700968468
Name:OPHTHALMIC CONSULTANTS OF SOMERSET,EYE MDS,P.A.
Entity Type:Organization
Organization Name:OPHTHALMIC CONSULTANTS OF SOMERSET,EYE MDS,P.A.
Other - Org Name:DANIEL L.WACHTEL,M.D. AND LARRY D.WEISFELD,M.D.,P.A.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:WEISFELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-356-7283
Mailing Address - Street 1:515 CHURCH STREET
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BOUND BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:08805-1743
Mailing Address - Country:US
Mailing Address - Phone:732-356-7283
Mailing Address - Fax:732-356-0432
Practice Address - Street 1:515 CHURCH STREET
Practice Address - Street 2:SUITE 4
Practice Address - City:BOUND BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08805-1743
Practice Address - Country:US
Practice Address - Phone:732-356-7283
Practice Address - Fax:732-356-0432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0278301Medicaid
NJ0421707Medicaid
NJ0278301Medicaid
C59587Medicare UPIN
NJ0278301Medicaid
NJ0421707Medicaid