Healthcare Provider Details

I. General information

NPI: 1679763551
Provider Name (Legal Business Name): BRUNSWICK EYE ASSOCIATES, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2007
Last Update Date: 12/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 CLEVELAND AVE
HIGHLAND PARK NJ
08904-1817
US

IV. Provider business mailing address

317 CLEVELAND AVE
HIGHLAND PARK NJ
08904-1817
US

V. Phone/Fax

Practice location:
  • Phone: 732-828-5190
  • Fax: 732-828-0677
Mailing address:
  • Phone: 732-828-5190
  • Fax: 732-828-0677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. ELAINE G HATHAWAY
Title or Position: PARTNER
Credential: MD
Phone: 732-828-5190