=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104965045
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARTIN SCHUB MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2007
-----------------------------------------------------
Last Update Date | 06/23/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 245 ENGLE STREET
-----------------------------------------------------
City | ENGLEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07631-2465
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-569-3434
-----------------------------------------------------
Fax | 201-568-4233
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 245 ENGLE STREET
-----------------------------------------------------
City | ENGLEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07631-2465
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-569-3434
-----------------------------------------------------
Fax | 201-568-4233
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPHTHALMOLOGIST
-----------------------------------------------------
Name | DR. MARTIN SCHUB
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 201-569-3434
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | MA021706
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------