Provider Demographics
NPI:1992990477
Name:YEKATERINA SHTEYN, OD, PC
Entity type:Organization
Organization Name:YEKATERINA SHTEYN, OD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YEKATERINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHTEYN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:973-994-1444
Mailing Address - Street 1:112 EISENHOWER PKWY
Mailing Address - Street 2:STE.129
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-4995
Mailing Address - Country:US
Mailing Address - Phone:973-994-1444
Mailing Address - Fax:973-994-2333
Practice Address - Street 1:112 EISENHOWER PKWY
Practice Address - Street 2:STE.129
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-4995
Practice Address - Country:US
Practice Address - Phone:973-994-1444
Practice Address - Fax:973-994-2333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00578100261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0002038Medicaid
NJ117263Medicare PIN