Provider Demographics
NPI:1780883652
Name:FORSZT, EDWARD ARTHUR JR (OD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ARTHUR
Last Name:FORSZT
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:EDWARD
Other - Middle Name:ARTHUR
Other - Last Name:FORSZT
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:5218 BERGENLINE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-5524
Mailing Address - Country:US
Mailing Address - Phone:201-974-2999
Mailing Address - Fax:
Practice Address - Street 1:5218 BERGENLINE AVE
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-5524
Practice Address - Country:US
Practice Address - Phone:201-974-2999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0A4557152W00000X
NJOA4557152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5134102Medicaid
NJ5958154OtherAETNA
NJ5958154OtherAETNA