Provider Demographics
NPI:1376873935
Name:B KUBICK OPTICIANS INC
Entity Type:Organization
Organization Name:B KUBICK OPTICIANS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:D
Authorized Official - Last Name:BARTELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO, HAD
Authorized Official - Phone:908-233-5512
Mailing Address - Street 1:110 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-2150
Mailing Address - Country:US
Mailing Address - Phone:908-233-5512
Mailing Address - Fax:
Practice Address - Street 1:110 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-2150
Practice Address - Country:US
Practice Address - Phone:908-233-5512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-05
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ003321156FX1800X
NJ00987237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0696100001Medicare PIN