MEDICARE: RICHARD S WITLIN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	MA03593300	NJ

General Provider Information

NPI Number	:	1063459212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD S WITLIN MD

Provider Business Mailing Address
First Line	:	557 CRANBURY RD
Second Line	:	SUITE 15
City	:	EAST BRUNSWICK
State	:	NJ
Zip	:	08816-5419
Country	:	US
Telephone Number	:	732-698-9300
Fax Number	:	732-625-0107

Provider Business Practice Location Address
First Line	:	557 CRANBURY RD
Second Line	:	SUITE 15
City	:	EAST BRUNSWICK
State	:	NJ
Zip	:	08816-5419
Country	:	US
Telephone Number	:	732-698-9300
Fax Number	:	732-625-0107

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	08/06/2010

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