Provider Demographics
NPI:1891031779
Name:GERALD BLUMBERG P.A.
Entity Type:Organization
Organization Name:GERALD BLUMBERG P.A.
Other - Org Name:DR, BLUMBERG'S EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:BLUMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:732-566-7700
Mailing Address - Street 1:1071 ROUTE 34 STE C
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-2174
Mailing Address - Country:US
Mailing Address - Phone:732-566-7700
Mailing Address - Fax:
Practice Address - Street 1:1071 ROUTE 34 STE C
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NJ
Practice Address - Zip Code:07747-2174
Practice Address - Country:US
Practice Address - Phone:732-566-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-20
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty