Provider Demographics
NPI:1972692598
Name:WERTHEIMER, ROBERT (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:WERTHEIMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 FAIRFIELD AVE
Mailing Address - Street 2:SUITE 4B
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-6424
Mailing Address - Country:US
Mailing Address - Phone:973-228-4990
Mailing Address - Fax:973-228-4464
Practice Address - Street 1:195 FAIRFIELD AVE
Practice Address - Street 2:SUITE 4B
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-6424
Practice Address - Country:US
Practice Address - Phone:973-228-4990
Practice Address - Fax:973-228-4464
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA69761207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G82059Medicare UPIN
065702Medicare ID - Type Unspecified