MEDICARE: DR. S.B. BREGMAN, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	4224	NJ

General Provider Information

NPI Number	:	1255387262
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. S.B. BREGMAN, LLC

Provider Business Mailing Address
First Line	:	2115 MILLBURN AVE
Second Line	:
City	:	MAPLEWOOD
State	:	NJ
Zip	:	07040-3724
Country	:	US
Telephone Number	:	973-763-5525
Fax Number	:	973-763-7541

Provider Business Practice Location Address
First Line	:	2115 MILLBURN AVE
Second Line	:
City	:	MAPLEWOOD
State	:	NJ
Zip	:	07040-3724
Country	:	US
Telephone Number	:	973-763-5525
Fax Number	:	973-763-7541

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. SALLY BETH BREGMAN
Credential	:	O.D.
Telephone Number	:	973-763-5525

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	06/02/2010

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