Provider Demographics
NPI:1104974864
Name:TRASTMAN-CARUSO, ELYSE RANDI (MD)
Entity type:Individual
Prefix:DR
First Name:ELYSE
Middle Name:RANDI
Last Name:TRASTMAN-CARUSO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 ROUTE 37 W
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-8050
Mailing Address - Country:US
Mailing Address - Phone:732-244-4400
Mailing Address - Fax:732-505-2171
Practice Address - Street 1:601 ROUTE 37 W
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-8050
Practice Address - Country:US
Practice Address - Phone:732-244-4400
Practice Address - Fax:732-505-2171
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236720207W00000X
NJ25MA08568300207WX0009X, 207W00000X
PAMD433749207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0337455Medicaid
NJ0337455Medicaid