Provider Demographics
NPI:1841315512
Name:FUERMAN, SCOTT (OD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:FUERMAN
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 1:55 E BLACK HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08232-2759
Mailing Address - Country:US
Mailing Address - Phone:609-641-2330
Mailing Address - Fax:
Practice Address - Street 1:55 E BLACK HORSE PIKE
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08232-2759
Practice Address - Country:US
Practice Address - Phone:609-641-2330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOA0434800152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2180901Medicaid
NJT77690Medicare UPIN
NJ2180901Medicaid