Provider Demographics
NPI:1275174476
Name:JB ROYAL LLC
Entity Type:Organization
Organization Name:JB ROYAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR / MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:BEDZRAH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:973-901-5042
Mailing Address - Street 1:99 LONGVIEW ST
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-4857
Mailing Address - Country:US
Mailing Address - Phone:973-901-5042
Mailing Address - Fax:
Practice Address - Street 1:301 MOUNT HOPE AVE
Practice Address - Street 2:
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-2130
Practice Address - Country:US
Practice Address - Phone:973-442-1777
Practice Address - Fax:973-442-2777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty