Provider Demographics
NPI:1487603643
Name:SHTEYN, YEKATERINA (OD)
Entity type:Individual
Prefix:DR
First Name:YEKATERINA
Middle Name:
Last Name:SHTEYN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 EISENHOWER PKWY
Mailing Address - Street 2:STE 129
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-4995
Mailing Address - Country:US
Mailing Address - Phone:973-994-1444
Mailing Address - Fax:973-994-2333
Practice Address - Street 1:112 EISENHOWER PKWY
Practice Address - Street 2:SUITE 129
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-4995
Practice Address - Country:US
Practice Address - Phone:973-994-1444
Practice Address - Fax:973-994-2333
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00578100152W00000X
NJTO00119800152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0002038Medicaid
NJ0002038Medicaid
NJ068454W8TMedicare PIN