=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689666091
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEVE SILBERBERG OD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2005
-----------------------------------------------------
Last Update Date | 05/05/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 935 ROUTE 34 SUITE 1A
-----------------------------------------------------
City | MATAWAN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07747-3283
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-583-9797
-----------------------------------------------------
Fax | 732-583-3634
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 935 ROUTE 34 SUITE 1A
-----------------------------------------------------
City | MATAWAN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07747-3283
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-583-9797
-----------------------------------------------------
Fax | 732-583-3634
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 27OA00396400
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------