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General NPI Number Information
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NPI Number | 1679763551
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Entity Type | Organization
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Legal Business Name | BRUNSWICK EYE ASSOCIATES, L.L.C.
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Dates
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Enumeration Date | 07/27/2007
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Last Update Date | 12/09/2011
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Provider Practice Location Address
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Address Line | 317 CLEVELAND AVE
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City | HIGHLAND PARK
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State | NJ
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Zip | 08904-1817
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Country | US
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Telephone | 732-828-5190
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Fax | 732-828-0677
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Provider Business Mailing Address
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Address Line | 317 CLEVELAND AVE
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City | HIGHLAND PARK
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State | NJ
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Zip | 08904-1817
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Country | US
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Telephone | 732-828-5190
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Fax | 732-828-0677
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Authorized Official
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Title or Position | PARTNER
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Name | DR. ELAINE G HATHAWAY
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Credential | MD
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Telephone | 732-828-5190
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State | NJ
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