Healthcare Provider Details

I. General information

NPI: 1851476881
Provider Name (Legal Business Name): RUTH ANDREA SALKIN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 02/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 PASCACK ROAD
WASHINGTON TOWNSHIP NJ
07676-4837
US

IV. Provider business mailing address

422 PASCACK ROAD
WASHINGTON TOWNSHIP NJ
07676-4837
US

V. Phone/Fax

Practice location:
  • Phone: 201-664-4477
  • Fax: 201-666-4290
Mailing address:
  • Phone: 201-664-4477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number270A00432100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number270A00432100
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number270A00432100
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number270A00432100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: