Healthcare Provider Details

I. General information

NPI: 1619936648
Provider Name (Legal Business Name): PAUL MANSFIELD HADLEY O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 01/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 SHAWNEE DR
WATCHUNG NJ
07069-5803
US

IV. Provider business mailing address

10 SHAWNEE DR
WATCHUNG NJ
07069-5803
US

V. Phone/Fax

Practice location:
  • Phone: 908-754-4333
  • Fax: 908-743-4334
Mailing address:
  • Phone: 908-754-4333
  • Fax: 908-743-4334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number02987
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: