Provider Demographics
NPI:1063598381
Name:TILONSKY, SAMUEL IRVING (OD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:IRVING
Last Name:TILONSKY
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 1:10 HADDON AVE
Mailing Address - Street 2:
Mailing Address - City:HADDON TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08108-2706
Mailing Address - Country:US
Mailing Address - Phone:856-854-6565
Mailing Address - Fax:856-854-3258
Practice Address - Street 1:10 HADDON AVE
Practice Address - Street 2:
Practice Address - City:HADDON TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08108-2706
Practice Address - Country:US
Practice Address - Phone:856-854-6565
Practice Address - Fax:856-854-3258
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-29
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00462600152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ35317OtherAETNA
NJNJ04626OtherVBA
NJ0082737000OtherAMERIHEALTH
NJ310782OtherNVA
NJ2282402Medicaid
NJ87925OtherSPECTERA
NJ1047635OtherHORIZON NJ HEALTH
NJ37913OtherDAVISVISION
NJ208567OtherAMERICHOICE
NJ87925OtherSPECTERA
NJ208567OtherAMERICHOICE
NJ0082737000OtherAMERIHEALTH