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General NPI Number Information
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NPI Number | 1316434624
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Entity Type | Organization
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Legal Business Name | FRIEDBERG EYE ASSOCIATES PA
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Dates
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Enumeration Date | 04/23/2018
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Last Update Date | 10/15/2021
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Provider Practice Location Address
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Address Line | 661 N BROAD ST
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City | WOODBURY
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State | NJ
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Zip | 08096-1621
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Country | US
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Telephone | 856-845-7968
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Fax | 856-845-8544
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Provider Business Mailing Address
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Address Line | 661 N BROAD ST
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City | WOODBURY
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State | NJ
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Zip | 08096-1621
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Country | US
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Telephone | 856-845-7068
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Fax | 856-845-8544
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Authorized Official
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Title or Position | PRESIDENT
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Name | HOWARD LYLE FRIEDBERG
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Credential | MD
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Telephone | 865-845-7968
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 31TD00355700
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License Number State | NJ
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