MEDICARE: ROBERT WERTHEIMER 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	MA69761	NJ

General Provider Information

NPI Number	:	1972692598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT WERTHEIMER MD

Provider Business Mailing Address
First Line	:	195 FAIRFIELD AVE
Second Line	:	SUITE 4B
City	:	WEST CALDWELL
State	:	NJ
Zip	:	07006-6424
Country	:	US
Telephone Number	:	973-228-4990
Fax Number	:	973-228-4464

Provider Business Practice Location Address
First Line	:	195 FAIRFIELD AVE
Second Line	:	SUITE 4B
City	:	WEST CALDWELL
State	:	NJ
Zip	:	07006-6424
Country	:	US
Telephone Number	:	973-228-4990
Fax Number	:	973-228-4464

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	07/06/2010

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