Provider Demographics
NPI:1326105032
Name:FOWLER, BERNARD J (MD)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:J
Last Name:FOWLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10 HIGH RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645-1550
Mailing Address - Country:US
Mailing Address - Phone:201-930-1824
Mailing Address - Fax:
Practice Address - Street 1:216 ENGLE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2444
Practice Address - Country:US
Practice Address - Phone:201-871-3414
Practice Address - Fax:201-871-4830
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02600200207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1145506OtherNJ HEALTH
NJ4255361OtherAETNA
NJ222258009OtherTAX ID
NJ222258009OtherBLUE CROSS BLUE SHIELD
NJ1995502Medicaid
NJBS730OtherOXFORD
NJ441181946OtherRAILROAD MEDICARE
NJJ31824OtherHEALTHNET
NJ222258009OtherBLUE CROSS BLUE SHIELD
NJ1995502Medicaid