Healthcare Provider Details

I. General information

NPI: 1376873935
Provider Name (Legal Business Name): B KUBICK OPTICIANS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2010
Last Update Date: 01/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 CENTRAL AVE
WESTFIELD NJ
07090-2150
US

IV. Provider business mailing address

110 CENTRAL AVE
WESTFIELD NJ
07090-2150
US

V. Phone/Fax

Practice location:
  • Phone: 908-233-5512
  • Fax:
Mailing address:
  • Phone: 908-233-5512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number003321
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number00987
License Number StateNJ

VIII. Authorized Official

Name: PETER D BARTELL
Title or Position: OWNER
Credential: DO, HAD
Phone: 908-233-5512