Provider Demographics
NPI:1952331704
Name:FISHBEIN, JONATHAN (OD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:FISHBEIN
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 1:2090 STATE ROUTE 27
Mailing Address - Street 2:STE 105
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-1142
Mailing Address - Country:US
Mailing Address - Phone:732-658-6765
Mailing Address - Fax:732-568-0041
Practice Address - Street 1:2090 STATE ROUTE 27
Practice Address - Street 2:STE 105
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-1142
Practice Address - Country:US
Practice Address - Phone:732-658-6765
Practice Address - Fax:732-568-0041
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOA 5536152W00000X, 152WL0500X
NJOA5536152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7650507Medicaid
NJU72045Medicare UPIN
NJ017384PM8Medicare ID - Type Unspecified