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General NPI Number Information
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NPI Number | 1164458154
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Entity Type | Individual
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Provider Name | ROBERT RICHARD VANDERYAJT OD
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Gender | Male
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Dates
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Enumeration Date | 06/23/2006
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Last Update Date | 01/28/2019
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Provider Practice Location Address
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Address Line | PLAZA 23 225 ROUTE 23
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City | HAMBURG
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State | NJ
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Zip | 07419
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Country | US
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Telephone | 973-823-0300
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Fax | 973-823-0038
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Provider Business Mailing Address
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Address Line | 225 ROUTE 23 PLAZA 23
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City | HAMBURG
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State | NJ
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Zip | 07419
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Country | US
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Telephone | 973-823-0300
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Fax | 973-823-0038
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 27OA00441400
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License Number State | NJ
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