Healthcare Provider Details

I. General information

NPI: 1538701032
Provider Name (Legal Business Name): YEKATERINA SHTEYN, OD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2019
Last Update Date: 10/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30-103A MALL DRIVE WEST
JERSEY CITY NJ
07310
US

IV. Provider business mailing address

112 EISENHOWER PKWY
LIVINGSTON NJ
07039-4995
US

V. Phone/Fax

Practice location:
  • Phone: 201-420-7733
  • Fax:
Mailing address:
  • Phone: 973-994-1444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: YEKATERINA SHTEYN
Title or Position: OWNER
Credential: OD
Phone: 973-580-0464