Provider Demographics
NPI:1881873321
Name:ROBERT G MIRSKY MD PA
Entity type:Organization
Organization Name:ROBERT G MIRSKY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:MIRSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:973-736-1016
Mailing Address - Street 1:745 NORTHFIELD AVENUE
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1144
Mailing Address - Country:US
Mailing Address - Phone:973-736-1016
Mailing Address - Fax:973-736-4869
Practice Address - Street 1:745 NORTHFIELD AVENUE
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1144
Practice Address - Country:US
Practice Address - Phone:973-736-1016
Practice Address - Fax:973-736-4869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0297003Medicaid
NJDG8115OtherRAILROAD MEDICARE