Provider Demographics
NPI:1871547943
Name:WASSER & EDELSTEIN, PA
Entity type:Organization
Organization Name:WASSER & EDELSTEIN, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:S
Authorized Official - Last Name:EDELSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:856-779-7595
Mailing Address - Street 1:38 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MAPLE SHADE
Mailing Address - State:NJ
Mailing Address - Zip Code:08052-2432
Mailing Address - Country:US
Mailing Address - Phone:856-779-7595
Mailing Address - Fax:856-779-7596
Practice Address - Street 1:38 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MAPLE SHADE
Practice Address - State:NJ
Practice Address - Zip Code:08052-2432
Practice Address - Country:US
Practice Address - Phone:856-779-7595
Practice Address - Fax:856-779-7596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-21
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4996152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0747818000OtherBC BS PA
568665OtherBC/BS PA
NJ641310201Medicaid
NJWA568665Medicare PIN
NJ568665Medicare PIN
NJ641310201Medicaid