Provider Demographics
NPI:1831149293
Name:DREIZEN, NEIL GREGORY (MD)
Entity type:Individual
Prefix:DR
First Name:NEIL
Middle Name:GREGORY
Last Name:DREIZEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 ROUTE 72 W
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-2414
Mailing Address - Country:US
Mailing Address - Phone:609-597-8087
Mailing Address - Fax:
Practice Address - Street 1:1206 ROUTE 72 W
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2414
Practice Address - Country:US
Practice Address - Phone:609-597-8087
Practice Address - Fax:609-597-7192
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05070100207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0593401Medicaid
NJ133977Medicare ID - Type Unspecified
NJ0593401Medicaid