Provider Demographics
NPI:1912071812
Name:SILVERSTEIN, BONNIE (OD)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:
Last Name:SILVERSTEIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-5027
Mailing Address - Country:US
Mailing Address - Phone:732-821-0318
Mailing Address - Fax:732-297-5278
Practice Address - Street 1:101 GRAND AVE
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-5027
Practice Address - Country:US
Practice Address - Phone:732-821-0318
Practice Address - Fax:732-297-5278
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27TO00090100152W00000X
NYTUV5880152W00000X
NJ27OA00552600152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0167983Medicaid
NY01794834Medicaid
NYC24501Medicare ID - Type Unspecified
NJ0167983Medicaid