Provider Demographics
NPI:1881637510
Name:NEUSIDL, WILLIAM B (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:B
Last Name:NEUSIDL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 COVENTRY DR
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-1973
Mailing Address - Country:US
Mailing Address - Phone:908-859-6055
Mailing Address - Fax:908-859-2042
Practice Address - Street 1:800 COVENTRY DR
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-1973
Practice Address - Country:US
Practice Address - Phone:908-859-6055
Practice Address - Fax:908-859-2042
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05614400207W00000X
PAMD033871E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6647103Medicaid
1174936-005OtherCIGNA
01000186100OtherAMERICHOICE
38675OtherAETNA US HEALTHCARE
OXFORDOtherQS026
NJ180023101OtherRAILROAD MEDICARE
1174936-005OtherCIGNA
NJ6647103Medicaid
NJ0506860001Medicare NSC