Provider Demographics
NPI:1952336141
Name:STEIN, AMY BETH (OD)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:BETH
Last Name:STEIN
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 1:1 KALISA WAY
Mailing Address - Street 2:SUITE 209
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652
Mailing Address - Country:US
Mailing Address - Phone:201-967-0519
Mailing Address - Fax:201-967-5100
Practice Address - Street 1:1 KALISA WAY
Practice Address - Street 2:SUITE 209
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652
Practice Address - Country:US
Practice Address - Phone:201-967-0519
Practice Address - Fax:201-967-5100
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005965152WC0802X
NJ27MA005786152WC0802X
CT002554152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC168A1Medicare ID - Type Unspecified
U86883Medicare UPIN
NJ090585T64Medicare ID - Type Unspecified