1396808820 NPI number — EARLE C. SCHREIBER, INC.

Table of content: (NPI 1396808820)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396808820 NPI number — EARLE C. SCHREIBER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EARLE C. SCHREIBER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396808820
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 BETHANY RD
Provider Second Line Business Mailing Address:
SUITE 13
Provider Business Mailing Address City Name:
HAZLET
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07730-1659
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-335-1424
Provider Business Mailing Address Fax Number:
732-335-1420

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 BETHANY RD
Provider Second Line Business Practice Location Address:
SUITE 13
Provider Business Practice Location Address City Name:
HAZLET
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07730-1659
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-335-1424
Provider Business Practice Location Address Fax Number:
732-335-1420
Provider Enumeration Date:
12/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WRIGHT
Authorized Official First Name:
MARGERY
Authorized Official Middle Name:
SCHREIBER
Authorized Official Title or Position:
BOARD CERTIFIED OCULARIST - PRESIDE
Authorized Official Telephone Number:
732-335-1424

Provider Taxonomy Codes

  • Taxonomy code: 156FX1700X , with the licence number:  NOT REQUIRED , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4057503 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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