Provider Demographics
NPI:1932500741
Name:BLEIBERG, ALVIN D (OD)
Entity Type:Individual
Prefix:
First Name:ALVIN
Middle Name:D
Last Name:BLEIBERG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 ROUTE 37 W
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-5018
Mailing Address - Country:US
Mailing Address - Phone:732-914-4721
Mailing Address - Fax:732-914-4765
Practice Address - Street 1:950 ROUTE 37 W
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-5018
Practice Address - Country:US
Practice Address - Phone:732-914-4721
Practice Address - Fax:732-914-4765
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ270A00558000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist